Mar 03

Hardest Part of Being a Therapist

Being a therapist: what’s it really like?

Several years ago psychologist Ryan Howes conducted The Seven Questions Project in which he asked “big names in the world of psychotherapy” a series of pertinent questions. Although not everyone answered his request to participate, the ones who did were thoughtful in their responses.

When I recently found his series of Psychology Today blog posts about this and reviewed his queries, the one I found most interesting was the fifth: What’s the toughest part of being a therapist? (For the others, click on the link provided above.) And then I read Howes’s own conclusion regarding the project, which included the following:

“Best Question: I thought it would be questions one, four or seven, but question five (the toughest part of being a therapist) turned out to be the most revealing.”

Below are selected excerpts of some of the therapists’ answers to this specific question.

Thomas Szasz(1920-2012)

Individual psychotherapy — that is, engaging a distressed fellow human in a disciplined conversation and human relationship – requires that the therapist have the proper temperament and philosophy of life for such work. By that I mean that the therapist must be patient, modest, and a perceptive listener, rather than a talker and advice-giver…

Even if the foregoing conditions are satisfied, the therapist’s task may not be easy or enviable, as he may be required to be passive in the face of the client’s self-destructive behavior and tolerate the client’s choosing to stick to his familiar, self-limiting life strategies and not risk entering on the path of liberation.

Harriet Lerner

The toughest part of being a therapist is that you constantly run up against your limitations.

Jeffrey Barnett 

One major challenge of being a psychotherapist is to pay attention to our own functioning, monitor our effectiveness, and to practice ongoing self-care…Just like our clients we must deal with life’s challenges and stresses.

Nada Stotland

Perhaps the most difficult aspect of doing psychotherapy is listening to and absorbing patients’ psychic pain.

Irvin Yalom

Well, I think it’s just holding so much pain at times. Worrying about my patients. Seeing some people that I really can’t help, who in some ways are beyond help. Or seeing a sociopath knowing I can’t really do anything for him or can’t reach him. Or watching some people who are throwing their lives away on drugs and there’s so little you can do about it.

James H. Bray

Not taking client’s problems home with you. Many people come for psychotherapy with significant emotional distress and pain. It is important to leave that with the client and not take it home with you.

John Gray

…Whenever I even start to notice a sense of frustration within myself I recognize that I’m not giving a very good message to my client. Whenever you’re frustrated with someone you’re telling them, “you’re not enough, you’re not doing it right, you’re not living up to my expectations.” That’s not helping the client, it’s not helping yourself.

Glen O. Gabbard

The toughest part of being a therapist is being truly “present” with the patient. The demands placed on a therapist in a typical day of psychotherapy are truly extraordinary. The therapist must be present in a way that allows the patient to feel heard, validated, and understood.

Donald Meichenbaum

The toughest part of being a therapist is how NOT to get caught up with all of the questionable psychotherapeutic “BULLSHIT” that pervades the field.

David D. Burns  

…Learning to accept failure on multiple levels is, to my way of thinking, the key to become a world-class therapist. But that means humility, and setting your ego aside, while you develop superb new technical skills.

Mar 27

Getting Rid of Anger: Venting It Out As a Solution Is Myth

One of the best things I’ve ever read about getting rid of anger is Carol Tavris‘s 1983 Anger: The Misunderstood Emotion. Although Tavris’s book was considered controversial at the time, her extensive research supported my own biases. ”Talking out an emotion doesn’t reduce it, it rehearses it,” she said. “People who are most prone to give vent to their rage get angrier, not less angry.”

Anatole Broyard, The New York Times, summarized some of her suggestions for getting rid of anger: “We can analyze and understand our anger; we can express it and go beyond it; we can use it, instead of letting it use us. As a last resort, we can, like the Papuans of New Guinea, do ‘a mad dance,’ a solution that quite a few of us are already practicing.”

In her New York Times review Jane E. Brody added another important piece: “Dr. Tavris does not believe anger should never be expressed. Rather, she limits the circumstances to those that satisfy three conditions: when anger represents a legitimate plea for justice, when it is directed at someone who is the cause of the anger and when it would result in a correction of the offense or, at the very least, would not cause retaliation. Otherwise, she suggests counting to 10.”

Despite the evidence, a belief still persists, however, that anger is best handled via some kind of dramatic venting. As recently as 2009, in their bestseller 50 Great Myths of Popular Psychology, authors Scott O. Lilienfeld, Steven Jay Lynn, John Ruscio, and Barry L. Beyerstein listed “It’s Better to Express Anger Than to Hold It In” as Myth #2. (Number 1? “We Only Use 10% of our Brains.”)

Why is this myth so popular? In all likelihood, people often mistakenly attribute the fact that they feel better after they express anger to catharsis, rather than to the fact that anger usually subsides on its own after awhile (Lohr, Olatunji, Baumeister, & Bushman, 2007).

From noted anger researcher Brad Bushman (Psychology Today): “Venting is just practicing how to behave more aggressively, such as by hitting, kicking, screaming, and shouting.” One might feel good afterward, but it’s not likely to change the way you feel overall.

Even physical exercise, he says, isn’t helpful. “The reason physical exercise doesn’t work is that it increases rather than decreases physiological arousal, such as heart rate and blood pressure. When people become angry, their physiological arousal increases. (It is possible, however, that prolonged exercise will eventually reduce anger, if it continues until the person is extremely tired—because then the arousal is finally dispersed and people feel too exhausted to aggress.)”

For getting rid of anger Bushman endorses such things as relaxing, counting to 10, reframing the problem or conflict, distraction, and detachment. Also, “petting a puppy, watching a comedy, making love, or performing a good deed…because those acts are incompatible with anger and therefore they make the angry state impossible to sustain.”

Below Steven Stosny, PhD, who regularly addresses anger management in his clinical work, presents his “Ten Commandments of Managing Anger” (Psychology Today):

1. Recognize anger as a signal of vulnerability – you feel devalued in some way.

2. When angry, think or do something that will make you feel more valuable, i.e., worthy of appreciation.

3. Don’t trust your judgment when angry. Anger magnifies and amplifies only the negative aspects of an issue, distorting realistic appraisal.

4. Try to see the complexity of the issue. Anger requires narrow and rigid focus that ignores or oversimplifies context.

5. Strive to understand other people’s perspectives. When angry you assume the worst or outright demonize the object of your anger.

6. Don’t justify your anger. Instead, consider whether it will help you act in your long-term best interest.

7. Know your physical and mental resources. Anger is more likely to occur when tired, hungry, sick, confused, anxious, preoccupied, distracted, or overwhelmed.

8. Focus on improving and repairing rather than blaming. It’s hard to stay angry without blaming and it’s harder to blame when focused on repairing and improving.

9. When angry, remember your deepest values. Anger is about devaluing others, which is probably inconsistent with your deepest values.

10. Know that your temporary state of anger has prepared you to fight when you really need to learn more, solve a problem, or, if it involves a loved one, be more compassionate.

Aug 17

Harriet Lerner: A Real Go-To Gal For Relationship Help

Psychologist and psychotherapist Harriet Lerner has a new book called Marriage Rules: A Manual for the Married and the Coupled Up. As always—as with her “Dance” series (The Dance of Anger, The Dance of Connection, The Dance of Intimacy, The Mother Dance) and other of her books—it’s been a big hit with her readers.

With 106 to choose from, it’s likely that couples will find something helpful in Marriage Rules. As stated in the book description, “If one person in a couple follows ten rules of his or her choice, it will generate a major, positive change. All that’s required is a genuine wish for a better relationship and a willingness to practice.”

Alisa Bowman of Project Happily Ever After recently conducted an interview with Harriet Lerner in which she addressed some salient points.

For one, why is being coupled up often so difficult and complicated? “Paradoxically, in our most intimate relationships we’re least likely to be our most mature and thoughtful selves. Because we humans are primed to flight and flee, even the best marriages will get stuck in anger or distance. To paraphrase the novelist Mary Carr, a dysfunctional marriage is any marriage ‘with more than one person in it.'”

On the issue of whether both partners need to read the book or work on change: “Often only one person has their motor running for change. That’s the person Marriage Rules can really help. While it takes two to couple up, it takes only one to make things a whole lot better.”

Because it’s such a challenging issue, there are 10 rules on “listening without getting so defensive”: “We all know that how we talk and how we listen determines how our relationship goes. But most of us are more motivated to improve our talking skills than the other half of the conversation equation…If we would only LISTEN with the same passion we feel about wanting to be HEARD.”

Like John Gottman (see yesterday’s post) Harriet Lerner is in a long-term marriage with another psychologist. She points out, though, that all marriages have ups and downs, the latter of which are often related to the impact of various stressors:

Generally speaking, nothing is harder on marriage than the addition and subtraction of family members: making or adopting a baby, step-kids, the empty nest, and so forth. And then there are the stressors we didn’t sign up for; addictions, chronic illness, affairs, unemployment, untimely loss—you can make your own list. Whether you’re going to face your worst times after three years or 30 is anybody’s guess.
We’re always unprepared when the universe plunks a serious challenge down in our path. I used to think that anticipating the worst things and worrying about them would magically keep them away. It didn’t work. Obviously, we’ll do best if we can take care of ourselves during the hard times, and be kind to our partner as well. The stronger our connections with friends, family and community before the crises hits, the better we’ll do.