The Therapeutic Relationship - Caring and Healing

by Michele Gustafson Wednesday, April 6, 2011

A wave of awe comes over me as Mary describes how she’s caring for her mother with Alzheimer’s and her 6 year old granddaughter, all while dealing with her own ulcerative colitis and depression.  Do I care about her and getting her beyond the depression that’s keeping her from sleeping, eating and enjoying the sweeter moments of her life?  Yes, I do. As do most therapists. It is why we enter the profession.

Do I care about her differently than her husband, her mother or her daughter?  Of course.  The way I care about her and hear her is entirely different from the way her loved ones do.  She and I are relating for her and about her.  I am committed to seeing her through to our intended outcome – free of symptoms, contented and lighthearted again.

Your therapist will come to know you in ways your loved ones do not.  He or she will come to understand you in each of the roles you play – wife/ husband, mother/father, grandmother/grandfather, sister/brother – and as an individual. 

For our 45 minute session, Mary’s needs, thoughts and feelings will have my complete attention and the benefit of my skills.  For this, Mary and her insurance company will pay me a fee. But that fee doesn’t mean I don’t genuinely care about Mary, or my other clients.

Understanding your therapist’s level of care for you is about understanding the nature of your relationship. It is not a relationship based on family or friendship.  It is centered on you and is not reciprocal.  You enter into a payment agreement with your therapist to care about you in a unique way – in a way that is responsive, useful and not particularly complicated. 

I will see Mary beyond this depression to enjoying life again.  At that time, we will wish each other well and say good-bye.  Someone else will occupy her chair and I will hear his story and his needs.  I will listen, I will care and I will help.

Michele Gustafson LMSW

Michele Gustafson, LMSW, DCSW practices in Grand Blanc and Fenton, Michigan.  She has over 25 years experience doing therapy, having received undergraduate and graduate degrees from the University of Michigan where she has taught psychology and social work.  www.michelegustafson.com


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Does Your Therapist Like You? One Therapist's Perspective

by Lynn R. Zakeri Tuesday, February 22, 2011

William Blake - Friendship

Most professionals in the helping profession chose their job purposefully.  We enjoy helping, listening, and problem solving.  I found an online quiz that supposedly determines if one would make a good therapist.  It asked questions about one’s understanding, ability to help others control emotions, make decisions, give feedback and read social cues.  These are definitely telling questions, but is there more to it?  Do therapists ever think of their clients as more than a job?  Do clients feel that they are genuinely liked?  I’ve written previously about the chemistry one must have with their therapist.  That chemistry can go both ways.

Are there clients I particularly enjoy seeing?  Yes.  Is it because they are nice?  Sure, they are nice.  But it is more their motivation to work during our sessions.  As a therapist, I am easy to please:  Show up for our scheduled appointments, call if you can’t or are running late, and then use your time well.  However, that doesn’t mean I “like” you any less if you don’t do these things.  I care about my clients.  I like them too.  Some I can say I really like, especially after having known them for many years.  But let’s be honest.  It is a one-sided relationship.  They may leave a session feeling better than ever, and I am fulfilled knowing together we worked hard, but while they may ponder our work well after the session is over, I am completely focused on my next client.

Many clients come into our session with a list of topics they want to discuss and work on.  But what is he or she feeling when they leave?  Some of my clients probably feel that I am proud of them based on our talk and the progress they have made, and that feeling may transfer to feeling like they pleased me and that they did well.  They leave with a smiling “thank you so much” and will sometimes tell me they repeated some of our conversation with their loved ones.  Feeling liked is part of that along with feeling accepted and cared for.   I have never been asked the question during therapy “do you like me”, but I confidently believe my clients would all say that I genuinely do.

Sometimes a client’s issue might be insecurities and that will transfer over to our relationship as well.  A client may leave wondering if he or she pleased me and answered “correctly” instead of processing situations through their own glasses (as opposed to mine).  Once confidence is built, it is my hope that their habit of changing behaviors to please me will become pleasing to themselves.

Some therapists say it is too draining to think about work when not working.  I can’t help but brainstorm and process throughout my days.  Is it draining?  Possibly.  But again, doing a good job is fulfilling.  I think 100% of my clients would tell you that not only do I like them, but that I like them best.  And for that 45-50 minute session, I do.

Lynn Zakeri

 

Lynn R. Zakeri is a licensed Clinical Social Worker with a private practice in Northfield and Skolie, Illinois. For more information view Lynn's website at www.lynnzakeri.com.

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Are the Winter Whites Getting You Down?

by Rich Caplan Wednesday, February 16, 2011

Montreal Plateau Day of Snow

With forecasters predicting more possible snow events, I believe that this New England winter deserves its own diagnostic category and for those of you effected by it (and please,who isn't?) we now have a new DSM IV diagnosis called "Snow Depression". This occurs, of course, when you have had just too much of the white stuff. 

Worried you might be suffering from snow depression? Below are a list of symptoms so you can tell when you have come down with snow depression*: 

  • The Weather Channel is starting to scare you. In fact, any mention of the word "weather" in any context is getting scary. 
  • You've seriously considered buying a snow plow. 
  • You've seriously considered moving to Florida. 
  • You realize that you have snow blower envy every time your next door neighbor plows out his driveway with his new 300 horsepower, triple action Z200 with heated handles and the ability to throw snow over a mile away. 
  • Your favorite section of the newspaper is the travel section and you spend hours looking at the pictures of palm trees on sandy beaches. 
  • At the mention of the word "snow" you throw yourself under your bed pleading to the higher power of your choice to please leave us alone. 
  • You have purchased enough "snow-melt" to treat the parking lots of all the malls on the east coast. 
  • So, if any of this sounds vaguely familiar you may be afflicted with "snow depression". Here, in the Boston area there is only one cure...knowing that the Red Sox are at their spring training complex in Florida, and the days are getting longer. 

    Now, don't you feel better already? 

    *Snow depression is not a real diagnosis. 

    Rich Caplan

     

    Rich Caplan has been a social worker since 1982. He specializes in addictive disorders and strongly believes in the healing power of laughter. His book, "Do I Really Have to Read This?" (a book for men about relationships) is available at Barnes and Noble.

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    Balaam and the Ass: A Metaphor for Psychotherapy

    by James Leffert Thursday, December 16, 2010

    James Leffert

    James Leffert is a Licensed Psychologist with offices in Framingham and Cambridge Massachusetts. View his HelpPro profile here.

    People looking for a psychotherapist often ask me about my philosophy or theoretical orientation. Typically, a few buzzwords roll off my tongue: "cognitive-behavioral", "developmental", "systems orientation". However, these words don’t convey what really happens when I collaborate with a client.

    Let me share a story with you. Sometimes, metaphors speak more loudly than technical terms or psychological concepts.

    The Story of Balaam and the Ass

    The story of Balaam and the Ass is an ancient story from the Biblical book of Numbers. The main character is a wizard named Balaam who was known far and wide for his expertise. The king of Moab hires Balaam to curse the Israelites. Balaam knows he’s not supposed to curse the Israelites but because the king promises to pay him well and perhaps also because Balaam likes playing an important role in world affairs, he agrees to do this. He saddles up his ass and sets out to the place where he can look down upon the Israelites and curse them.

    Balaam is riding along the road when all of a sudden the ass swerves off the road into a field. Balaam takes up his whip and starts to beat her to get her back on the road. They continue on as the road travels along a narrow space between two high walls, and the ass swerves again, this time over to the wall so that Balaam’s foot is squeezed against the wall. Again, Balaam beats her. Finally, where the area between the two walls is so narrow that there is no room to swerve, the ass goes no further, but simply comes to a complete stop and lies down on the ground. 

    At this point, Balaam is furious and beats the ass with a stick. Suddenly, however, a miracle occurs—the ass is given the gift of speech. As if there is nothing at all unusual about it, the ass opens her mouth and says to Balaam, “What have I done to you that you have beaten me these three times?...Look, I am the ass that you have been riding all along until this day! Have I been in the habit of doing thus to you?” And Balaam answers, “No.” At this point, Balaam’s eyes are opened and he sees that an angel is standing in the way, blocking their path, with a drawn sword in his hand.

    Making Sense of the Metaphor

    What does this story have to do with psychotherapy? The way I see it, we all pursue various objectives in life. Often, we try to move in a certain direction but like Balaam, we keep running into obstacles. We try different approaches, sometimes on our own, other times at the urging of others, but we don’t make progress. Often, this is what prompts people to seek help from a psychotherapist. At this point, we experience distress and pain. Others may be getting mad at us and we may get fed up with ourselves, and we (along with others) start beating up on ourselves, getting frustrated and self-critical because of our inability to make improvements. This is like Balaam flogging the ass, which represents that part of himself that is trying to propel him forward to where he wants to go.

    The psychotherapist’s job is to help the client (and others around him or her) to stop the flogging and open their eyes and discern the angel standing in front of the person, blocking his or her path.

    The angel represents whatever hidden reasons are blocking the way.

    Each of us has our own unique obstacle that the angel with the sword symbolizes. The point is that when we stop flogging ourselves (and, at times, stop letting others flog us) and look at our situation in a new way to discern what is actually standing in the way, we can then figure out a way forward. Sometimes it involves a change in ourselves, sometimes it involves locating a detour that enables us to take an end run around the obstacle, and sometimes it involves reassessing and modifying our objective.

    This story helps me convey, through metaphor, my view of psychotherapy as a paradigm-shifting experience that helps us identify, make sense of, and eventually overcome obstacles in our lives. 

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    The 15 Minute Decision: Is This the Right Therapist for Me?

    by Karen Wulfson Thursday, December 2, 2010

    Karen WulfsonKaren Wulfson is a licensed Marriage and Family Therapist with a private practice in Beverly Hills, CA. Please visit her website for more information: www.karenwulfson.com

    “What kind of therapy do you do?” This was the first hesitantly-voiced question I heard yesterday afternoon, from the man who eventually decided to schedule an appointment. What my caller really wanted to know was, “can you help me?”

    In the 15-minute space between that question and his decision to actually make an appointment, something magical happened. At least that’s how I see each one of these “firsts.” That first phone call, first session, first time revealing some challenging personal history – for me these are magical gifts given to me by those reaching out for help.

    I know it’s not easy to contact a therapist you’ve never met, as you search for someone to talk to, someone to help you manage those challenges life brings to us all. But yet, it usually takes no more than 10-15 minutes of conversation for most people to decide if they feel we’re a match and to decide if I might be able to help.

    So – what’s that magic about? I’m always curious about what happens to quickly turn strangers into bonded pairs. What is it I do or say to let a caller know that I really do understand and that I have the knowledge to help him through those tough times? I can create some of that magic by paying attention, responding as directly as possible to questions, and by recognizing what I can and cannot do. I can help that bond by just being me – as honestly and ethically as possible. And sometimes, being honest and ethical might mean that I refer to someone else, when I don’t think I’m the right therapist for this person. And, I firmly believe that people feel more hopeful when they understand that I’m making an effort to learn about their needs and to see if we’d be a good match.

    How can you decide if the magic is there? How will you know when it’s right to trust and when you should be wary? And, how will you know whether this person you’ve never met can be trusted to honor and understand your experiences? You are the one who knows yourself the best. And you do have the ability to figure this out.

    Trust your instinct! That first call is a mutual interview, as you each decide if this will work. This call is an introduction to a therapist’s style. Pay attention to your inner voice. Do you feel welcomed and respected?  Starting to feel that magic? Feeling that this just might work out? Do you have a sense that this therapist is familiar with your challenges and can help? Not all of us can help every person. It’s the job of both the therapist and the client to pay attention and to bow out, when it’s clear this just doesn’t feel right. Pay close attention to that little voice and you’ll know when that magic bond seems likely. Then use the next session or two to find out if you were right!

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    Shopping for a Therapist?

    by Peg Haust-Arliss Wednesday, December 1, 2010

    Peg Haust-ArlissPeg Haust-Arliss is a Licensed Clinical Social Worker and Certified Cognitive Therapist specializing in anxiety disorders. She has a private practice in Seneca Falls, NY. For more information about Peg and her services, visit her website at www.PegHaust.com. 

    When it comes to choosing a therapist I look at it this way; finding the right therapist is like trying on new running shoes. Sometimes you find a pair that fit just right first try but, sometimes you have to try on a couple pair and compare the fit, or sometimes you have to run around the block a couple of times to be sure of the fit. 

    I find it helpful to look at it this way especially if you have had therapists before that did not seem particularly helpful for you. Very likely, the therapist that was not right for you was just right for someone else! 

    So, how do you begin? 

    I suggest, before calling that first prospective therapist, prepare with a list of questions. Ask yourself: 

    • What do I hope to accomplish with sessions?
    • What are my expectations for therapy and for the therapist?
    • What I am hoping to gain; support? direction? tools? skills?

    The more specific you are about what you want out of sessions the easier it will be to find the right therapist for you. 

    Next, call prospective therapists. Don't be afraid to ask them questions pertaining to how they can help you; after all, they will have plenty of questions for you! You might ask: 

    • This is what I want to accomplish in sessions; have you had success helping others with this? 
    • Do you have a specialty? 
    • How often can I be seen? 

    Don't forget to ask about payment and insurance too. And check out their website if they have one. 

    If you are comfortable you can also ask your doctor, friends, and family who they might suggest in your area. 

    Finally, assess how you feel after talking with a potential therapist or their office for the first time. Did they welcome your questions and answer confidently? 

    Remember, finding the right therapist, like finding the right running shoe, is vital to comfort, performance AND results. So, if the shoe fits...

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    The Chemistry Connection in the Therapeutic Relationship

    by Lynn R. Zakeri Friday, November 12, 2010

    Lynn ZakeriLynn R. Zakeri is a Licensed Clinical Social Worker with a private practice in Northfield and Skokie, Illinois. For more information view Lynn's website at www.lynnzakeri.com

    It is that old-fashioned phrase “have chemistry”, and scientific or not, you’ve got to have it with your therapist.  .  Whether you are looking for a listener or a problem solver, a sense of kindness or a motivator, you still need that chemistry. 

    How do you meet people is a question that is often asked, but really, what we are asking is how do we meet people we like, connect with, enjoy, and feel good around.  We talk to many people throughout our day, whether it is at our morning coffee shop, on a school playground, at the office, but who would you like to spend your free time with?  Who makes you laugh or brings out your funny-side?  Who do you have chemistry with?

    Literally, chemistry is the study of how matter interacts.  When we talk about chemistry with another person, we commonly refer to the love/attraction type of chemistry, but really just interacting positively is a general type of chemistry that we all strive to reach with others.  This type of interaction is so powerful, that it not only puts you in a good mood, but some research has shown that by releasing a certain chemical, phenylethylamine (PEA), this type of chemistry with another person may even make you happy and possibly resist depressive feelings.

    Adolescents often say the now-cool word “aaaawkward” when describing certain encounters, but in truth, so many encounters are!  A hint of sarcasm that was taken seriously; a lag in conversation where you say something you regret just to fill the silence; or you’ve exposed too much and experience the “TMI brush-off” (too much information).

    But when it’s good, it’s good.  Time flies, you don’t remember why but you know you laughed… hard.  And you are comfortable.  You are validated.  You are valued and never judged.  Similar to finding the right therapist.  The therapeutic relationship too requires chemistry.  And when it’s good, it’s good.

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