Posted by Hermitian on February 17, 2008, at 14:42:08
I visit this page once in a while and I cant figure out how it applies to Psychology. Most of the posts are about patient therapist relationships rather than psychology. Which is okay I guess as far as it goes. But there are a few things I dont get from reading the posts here.
One is the length of time of some therapist patient relationships. Some of them apparently last for years. What exactly are the therapeutic goals in those relationships? Does the therapist ever explicitly spell those out? At what point is a therapist obligated to tell a patient that he/she has taken them as far as they can go? In my view, the implied open ended therapist-patient relationships border on malfeasance. I.e. the therapist using a patient as a cash cow without providing any real additional clinical benefit. In fact he/she just may be an enabler for someone who has unfortunately reached a sub-optimal plateau.
The second question I have is related to the apparently excessive focus of session dialogs on past events. Once what has happened in the past is acknowledged to be true, whats the point of rehashing old ground? Its like seeing a bad movie and then consciously choosing to see it over and over again. Why would you pay somebody $200 over and over to recount that over and over? At what point does the dialog become future focused? Apart from the hugs and soothing conversation, what therapeutic mechanism drives improvement in the patient? In fact, if the therapist consciously steered the dialog into a future seeking direction, maybe the hugs and soothing would not even be necessary because the focus is positive. Is it so hard to understand that you get what you focus on? You focus on pain, you get pain. You revisit the same crummy life experiences over and over with a therapist, all it gets you is poorer. Does it not make sense that if you change your focus to a positive outcome and you are much likely to realize one?
Thirdly, do any of these therapists treat a patient holistically? I mean suggest they exercise and diet properly and engage in an active social life? And even beyond suggesting, actually challenging them in an appropriate way to step up holistically. I.e., ask them to commit to inter-session activities like diet, exercise and engagement that can catalytically inspire psychological improvement. Here too, unless the therapist treats a patient like a whole person rather than just a repository of bad memories then hes doing the patient a disservice regardless of his level of empathy.
Now where do I come from dropping out of the sky, issuing these kinds of comments? Well I started seeing a psychiatrist for ADD in the beginning of 2007. And of course I carried along some other baggage with that. So I then had talking sessions with him every two or three weeks for the better part of the year. And the discussion framework focused around one implicit rule and one objective. The rule was to minimize past thinking because it provides no value once it has been harvested for understanding. And the objective was to take a complex psychological architecture that I had constructed and simplify it down as much as possible. So the past was surfaced, acknowledged and then put in the back of the closet where it belongs. And planning a future around complexity takes too much energy. Why not make it simple? So we disassembled the architecture into more simple components of connecting activity to objectives. I asked my guy one time early on why I was behaving in an unproductive manner even though I was taking medication and it was working. He looked at me straight on and told me, Because you want to. Youd rather do that than do something productive. The only thing thats going to change that behavior is you finding a more compelling reason to spend your time another way. I cant tell you what you want fundamentally. Thats your job to figure out. So why dont we talk about future objectives that are more compelling?
Id love for anyone on this forum to tell how he has it wrong. Im not universally knocking therapy or therapists. And I would never suggest a treatment strategy for anybody including dissuading them from abandoning long term therapeutic relationships. But I would suggest to the people that gravitate to this forum whove have had protracted relationships with therapists yet still feel dependent, that they sit down with them and map out a therapeutic game plan that points forward and an exit strategy.
Is it just me or what?
Good Luck to You All
SteveM
Out
poster:Hermitian
thread:813285
URL: http://www.dr-bob.org/babble/psycho/20080210/msgs/813285.html