Sunday, September 20, 2009

Do you want to know a (therapy) secret?

Most people have no concept of how to be a patient in psychotherapy, and how could they?  In any other medical practice your role is more or less passive, you describe your symptoms and the doctor makes them go away. In therapy there isn’t a singular consensus on how therapy works, or what it can do. That the process requires your blind faith and resembles voodoo doesn’t make it any easier for the patient to actively engage, challenge, and utilize the therapy. Did you know that it’s the patient who determines the extent of the success of the treatment (according to the APA, successful therapy is due to “patient factors” rather than “therapist factors”)? The best metaphor that I can come up with is that you don’t lay the hammer next to nail and expect the obvious to unfold without some sort of involvement on your part. So much if this is on you, but it can’t happen without the hammer, nail, and the action between the two.
Therapy is expensive, it’s difficult, confusing, oftentimes involves pain and loss, but in the right hands it does amazing life-altering things. Do you know how to get the most out of therapy? Do you even know what’s possible within each session?  Do you know if your therapist is any good? How do you know if you should go to therapy?

I rarely see patients maximize the therapy’s potential to facilitate healing, change in self-concept, and the discovery of a more authentic life without first having to fight through  resistance. Patients waste enormous amounts of time fighting against the therapy in a Herculean effort to remain passive, and forever locked into an expectation that the world change for them, rather than understand how impossibly hard they need to work to manifest the changes they seek. Patients often intervene against the therapist in an attempt to undermine their own therapy or reject the therapist at the expense of looking at the therapy itself as a way to communicate injury and discover a remedy. And too often, the patient fails their job on the most basic level; they aren’t informed consumers of the process. The more informed the patient the more powerful the therapy. As a therapist, I’m tired of seeing the process diluted by the patient when there is so much more a kind of potency available to them in the room.

But before we can get to that, there's this first thing to get to, and that's all about why you're here. What was happening the moment you decided to call and book a session, and then, what you want to come next? People make the call because they're in pain, and nothing gets done until that pain is addressed and there's some sense of hope about what happens next.