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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 37 to 61 of 84. Go back in thread:
Posted by mair on December 3, 2004, at 22:48:08
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by multitask on December 3, 2004, at 11:34:14
Back on the issue of procedures - take the initiative to change or reiterate or clarify them when it's necessary. I went for ever thinking it wasn't ok to ever call my T at home when she was thinking the whole time that I understood that I could.
Don't jump in too quickly to bail out a client who's struggling over what to say.
Don't finish your patient's sentences - my T does sometimes because she's either taking pity on me for struggling so much or she's impatient waiting for me to finish - I wouldn't mind so much except she very frequently supplies the wrong ending to my unfinished sentence. It makes me feel that she really doesn't understand.
This is tough, but don't always supply the rational counterpoint to a client in distress. Sometimes I don't want her to help me process my misery, but just to share it.
I also agree that it's preferable to acknowledge a patient you run into outside of the office. You don't need to stop for conversation necessarily, but the acknowledgement part is important.
Mair
Posted by dawnfawn on December 4, 2004, at 11:16:55
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by mair on December 3, 2004, at 22:48:08
1. Don't be late. If you are late don't be late at the first visit. Don't be late consistently.
2. Don't watch the clock.
3. Please remember my name and pronounce it correctly.
4. Please explain your orientation and your thoughts on how long this will take.
5. Please explain any types of take home homework or reading, don't assume I understand you.
6. Please go over your notes from last time before we meet. It is my dime we are running on here.
Posted by dawnfawn on December 4, 2004, at 11:30:02
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by dawnfawn on December 4, 2004, at 11:16:55
> 1. Don't be late. If you are late don't be late at the first visit. Don't be late consistently.
> 2. Don't watch the clock.
> 3. Please remember my name and pronounce it correctly.
> 4. Please explain your orientation and your thoughts on how long this will take.
> 5. Please explain any types of take home homework or reading, don't assume I understand you.
> 6. Please go over your notes from last time before we meet. It is my dime we are running on here.
7. Please, Please if you don't think you can help my type of problem or if you think it needs medicine or some other approach, Please do not wait until three months have gone by to let me know.
Posted by simcha on December 4, 2004, at 18:15:28
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by dawnfawn on December 4, 2004, at 11:30:02
> > 1. Don't be late. If you are late don't be late at the first visit. Don't be late consistently.
Absolutely.
> > 2. Don't watch the clock.
Sorry, this is a clinical issue. I keep the clock behind my client. I must hold the frame (keep the boundaries) to 50 minutes. It's very important to treatment because most people have some sort of issue with boundary setting. Therefore ALL clinicians MUST look at a clock. It's a clinical issue. Some of us are just more discrete about it. I even mention, "Hey we have 10 mininutes left in the session, is there anything else that is brewing that you need to address." Then at five minutes before the end I do the same. Clients seem to appreciate this because they feel included in the clinical boundary setting. I also keep a clock in the client's view that is synchronized to my clock I'm usiing. Therefore they know how much time they have.
> > 4. Please explain your orientation and your thoughts on how long this will take.
Explaining orientation is sticky. Most therapists in the San Francisco Bay Area are Psychodynamic and it often takes years to do this kind of work. I use psychodynamic techiques and I'm transpersonal so I believe that the healing comes in the relationship and the spiritual heath of the therapist. Other than that I use CBT, family systems, a little Hakomi (for body tracking), and a host of other theories that fit each client. Sometimes I don't know what orientation the client will respond to the best for a while.. I've started using sandtray with one client who is very non-verbal. This seems to work fantastically for him.
Now as for how long it takes? It takes as long as it takes... It seems that clients come in with "tip of the iceberg" issues when in fact "like all icebergs" there is a whole lot underneath. Sometimes this takes months. Sometimes it takes years. It depends on what the client wants.
> > 6. Please go over your notes from last time before we meet. It is my dime we are running on here.
No, we do not share notes unless you specifically request it in California. Then we sit with you and explain the notes. Sometimes seeing your notes is very damaging to your therapeutic process because the notes usually show a progression of unconcsious material that you may not be ready to deal with. Also clinicians may change courses in the middle of treatment if they have found that their treatment is not working for the presenting issues and/or the presenting issues is changed. Sometimes diagnosis and assessment is ahuge burden to carry for some very disturbed clients. Of course, even they have a right to see the notes. You still must ask the therapist first and process why you want to see the notes. This is a major clinical issue. The notes belong to you and yet they really don't. You have a right to see them. The clinician has a right to keep them and to be the gatemaster/
> 7. Please, Please if you don't think you can help my type of problem or if you think it needs medicine or some other approach, Please do not wait until three months have gone by to let me know.Sometimes it takes months to convince a client that they need medical attention and medication. Also, n the course of therapy, your psyche opens up and many things may bubble to the surface. This might take months or years before a therapist would feel that it would be competent to refer you to a physician for medical evaluation and treatment.
That's my two cents as a therapist in training...
Simcha
Posted by simcha on December 4, 2004, at 18:46:59
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by dawnfawn on December 4, 2004, at 11:30:02
Ooooh,
I hope I did not come across as a "know it all" in the last thread. I was just showing you what the latest training is teaching us about the issues you were bringing up...
As with anything in the psychotherapy world, these things most likely will change. After all, pscychotherapy is only just over 100 years old. It all started with Freud, the psychoanalyst coke-fiend and quack. Then there was Jung who had complete nervous breakdown after Freud severed their relationship. Can we say that Jung had some MAJOR attachment issues? lol ;-) Also Jung found it "therapeutic" to have sex with his clients. Can you imagine what modern licensing boards would have done to him? EEK!
So psychotherapy started off on very shaky ground. We are just starting to reach our adolescence as a discipline. Give us time.
Simcha
Posted by peacefeline on December 4, 2004, at 19:47:36
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » dawnfawn, posted by simcha on December 4, 2004, at 18:46:59
Simcha,
Your replies to these items was very interesting. My T doesn't say very much about what she's doing, or therapy in general (which is OK, and I'm sure she would if I asked her, but there's always so much other stuff to talk about!)
Your perspective is especially valuable b/c you can see things from both sides, the client and the T.One more for the list:
Please don't interrupt very much! I know we all interrupt as a general rule, and most of us are used to this in conversation, and it's easy to overlook when it's not done in excess. But some ideas are hard enough to get at, without being interrupted three or four times in as many minutes.Susan
Posted by 10derheart on December 4, 2004, at 20:24:35
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » dawnfawn, posted by simcha on December 4, 2004, at 18:15:28
Regarding T's notes, I think you may have misunderstood Dawnfawn's meaning...I think the idea was if T. pulls out our chart, or whatever they use to refresh their memories in preparation for the session, she prefers T.s do that before we come in. At least that's how I took it - sort of picturing a T. possibly reading quietly (or not so quietly!) to themselves while client sits, maybe feeling both impatient and uncomfortable as T. "catches up" from last time. Personally, I don't mind it (only happened rarely) as long as they interact a bit while doing it, and don't take forever. I'm guessing Dawnfawn may have had a different (more irritating) experience entirely.
But your comments on the other aspect of clients wanting to see notes were well taken. That topic has been addressed a couple of times before on this board, and it's always an interesting and eye-opening discussion, with all the different experiences people have had with this delicate and potentially explosive area.
Hope you keep posting. I'm sure most people truly appreciate your unique perspective. I have learned so much from GardenerGirl (and I know someone else is training to be a T., darn my memory..?!), and it's great to have to the chance to do the same with you. Your writing style is wonderfully clear and easy to follow (not that that's a requirement on Babble - thank goodness for me! :)) ---10DerHeart
(PS: Dawnfawn, please correct me if I clarified incorrectly on your behalf, and pardon me if I am really inarticulate today. I wrote an email to former T. a couple hours ago, and since then, my brain feels turned to mush as far as stringing together words is concerned.)
Posted by messadivoce on December 5, 2004, at 0:01:45
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » dawnfawn, posted by simcha on December 4, 2004, at 18:15:28
I feel like I have to add my $.02 about some of your comments, I can't resist. About the clock issue, my T did watch the clock but he did it very discretely and I did have a clock in my line of vision. I watched it a lot early on and it was actually used "against" me (why are you watching the clock?). But as things got more intense, I tended to place the timeframe of the session completely in his hands and not ever look.
It's probably true that some clients have "boundary issues" about time, but what I loved about my T was that he wasn't afraid to go a little over if we were deeply into an issue that was not going to be resolved quickly. Once, about 15 minutes before a session ended, I worked up the courage to tell him about a particularly traumatic event. We ended our time together 10 minutes late, but I needed that extra time to be able to finish my thoughts and process it a little before I was herded out the door. I think a good T knows when those special circumstances are occuring. I also have issues about feeling gyped (attention wise) by my dad, and when my T would give me all my time plus a little extra, that went a long way towards me trusting him.
About treatment method, if the client asks about your method, I think it's best to share honestly. Had I known that my T was psychodynamic and therefore used the relationship that we developed, I might have been more prepared for the feelings I developed for him that he encouraged. I was pretty bowled over the by love/transference and I felt pretty blindsided by it.
Posted by Susan47 on December 5, 2004, at 11:20:18
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » simcha, posted by messadivoce on December 5, 2004, at 0:01:45
So strange that I would be going into a thread I don't investigate much and this would happen. Psychodynamic? Love and Transference? Jesus, the light went on. Ah.
Is that the way my therapist operates? He kept telling me (Meat Loaf runs through myhead, "She kept on tellin' me, she kept on tellin' me, she k-e-p-t on telling me, I want you, I need you, but I'm never gonna..." )....I do my thing, other therapists do theirs, I'm not familiar with anybody else's work ..."And that's as much as he ever elaborated about his methods, if he had any. I know it felt like he was riding the crest of an emotional wave, he kept on pulling me up to ride the top of the wave, work at things from the top of my mind, try not to touch the deeper underneath.
I fell in love with him like nobody else I've ever known.
Posted by Susan47 on December 5, 2004, at 13:17:24
In reply to Re: Babble Guide to Therapists: Do's and Don'ts » dawnfawn, posted by simcha on December 4, 2004, at 18:46:59
And here I am, *wishing* that my therapist would've had sex with me, lol!
Posted by simcha on December 5, 2004, at 15:38:22
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by Susan47 on December 5, 2004, at 13:17:24
> And here I am, *wishing* that my therapist would've had sex with me, lol!
That is a very normal reaction in therapy. Perhaps he's the first man who has takent the time to really get to know you. Perhaps it's the first time you have felt safe enough to open yourself up completely to a man.
This is all part of the healing process. The hope is that you can find this out in the world as a result of the treatment with another man.
Also, it would not be a good idea for a therapist to share everything about a treatment plan or style. There is such a thing as transference...what the client feels or thinks and projects onto the therapist. This is very important and necessary for the therapeutic process. It would ruin the entire therapy to explain all of the transferences and counter transferences...
Therapy is the place to be bowled over like you've never been bowled over before. That way when it happens in the outter world (outside the office) the client has the ability to deal with the feelings in a more adaptive manner....
Simcha
Posted by cubic_me on December 5, 2004, at 16:44:19
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by simcha on December 5, 2004, at 15:38:22
>
> This is all part of the healing process. The hope is that you can find this out in the world as a result of the treatment with another man.
>
> s. It would ruin the entire therapy to explain all of the transferences and counter transferences...
>
> Therapy is the place to be bowled over like you've never been bowled over before.
>
>Sometimes I want to know the whole story, then I can feel like I am part of my own treatment. Just because I know that a feeling is transference doesn't make it any less real. Also sometimes some of us don't want to be bowled over by transference, however much it may help. When I was deep in transference I wished I could just forget about it and get on with all the things I needed to do - but I couldn't, and my T wasn't there every second of the day to help me through it. So I guess I was dealing with transference 'in the real world', i didn't have any coping strategies and I felt completely alone...until I came here and found out what was happening when I was in the T's office.
Posted by messadivoce on December 5, 2004, at 17:15:26
In reply to Re: Babble Guide to Therapists: Do's and Don'ts, posted by simcha on December 5, 2004, at 15:38:22
>>> Also, it would not be a good idea for a therapist to share everything about a treatment plan or style. There is such a thing as transference...what the client feels or thinks and projects onto the therapist. This is very important and necessary for the therapeutic process. It would ruin the entire therapy to explain all of the transferences and counter transferences...>>>
Hmm, I think knowing that such a thing was normal would have helped a lot. My T did not provide info fast enough for me, so I went out and did my own research, which took a long time and required me to wade through a lot of nonesense. I was relieved to discover that there was a name for what I was experiencing, and that it was pretty normal. If only he had told me what was happening and that it was normal (instead of my coming to that conclusion myself) I could have saved myself a lot of time, worry and pain. My point is, if your client has insatiable curiosity, we will try to find out what's going on, and the info we get might not be what you'd want us to hear (it may be erronious or unprofessional) so it's better if you tell us yourself what's going on (and you don't have to tell us everything, but a little enlightenment helps).
>>> Therapy is the place to be bowled over like you've never been bowled over before. That way when it happens in the outer world (outside the office) the client has the ability to deal with the feelings in a more adaptive manner....>>>I sort of agree with this, but I think that only someone who has experienced the pain of transference and longing is truly qualified to make such a statement. Maybe you have experienced such a thing and it was beneficial to your treatment. To that effect, I was totally unprepared to deal with my immense feelings for him, and as cubic said, I had to deal with it myself most of the time...I look back on that period of my life and realize how much agony I was in because my T seemed to call forth such strong emotions that I then had to deal with myself until I saw him again. Yes, therapy is supposed to shake up your world, but after a certain point I think it can do more harm than good.
My termination was somewhat problematic due to his inconsistancy with post-termination communication. I wonder if the promises he made to me had more to do with counter-transference than inexperience. I'll never know, because though he shared that he experienced countertransference, he never went into detail (this was at the end of my treatment). So I'm left to put the pieces together myself, and there's a lot missing.
That having been said, in defense of my T, he handled my feelings skillfully even if he didn't always clue me in. And yes, I did learn that there was at least one trustworthy man in the world, and my experience with him has colored my feelings about other people, for the better. I owe him a lot of my happiness. I feel a great deal of love and affection for him that I know goes around and through transference.
Posted by Susan47 on December 5, 2004, at 22:06:26
In reply to Re: simcha, posted by messadivoce on December 5, 2004, at 17:15:26
I agree with the last poster that it would've helped me to know what was going on in therapy. As people, we are *not* all the same and there are many many ways of thinking and approaching things, also many ways of interpreting and living through feeling.
I disagree with the theory, used in therapy as discussed above, that it's in the patient's best interest to hide disclosure of psychodynamic dynamics (Heeheehee, Susan you're a nut....
Posted by simcha on December 5, 2004, at 23:46:41
In reply to Re: simcha, posted by Susan47 on December 5, 2004, at 22:06:26
Yes,
And consider this... When you go in for surgery (and the analogy is apt for therapy for those of us who have walked the path) the surgeon explains what they are going to do and what you might expect. Yet, in the end, each person is different and the effects in recovery vary greatly. They can't predict it. Neither can therapists.
Some things must be held by the therapist until the client's ego structure has grown enough to be able to handle what is actually happening.
Like denial: It is not my job to pop someone's denial. It is my job to explore all of the detrimental debris of the tornado that is really in the room that the client can't see. It is a lack of respect for the client for me to point at the tornado and tell them that that is the monster that they MUST deal with to get better. It's much better and it honors the client's own ability to heal to hold certain things.
Those of you who have gone on-line and investigated are brilliant. That is precisely what the therapist is looking for. You find your way to wellness. We are guides. Guides on quests do not reveal the goal and the place where the querant is going. That would be arrogant. The guide may be wrong in their own judgments.
I honor my clients' abilities to heal themselves and walk their paths with them. I might point out a stone or a tree or a bramble along the way, but it is not my job to blow away coping techniques that have allowed many clients to cope most of their lives just fine without me.
The coping mechanisms have become maladaptive. It is up to the client to see that and to develop the new more adaptive mechanisms with the therapist's guidance.
We walk on a knife's edge in the room with clients. And yes, we make mistakes. I do in every session. And I point them out to the client. That way they can see that I am human too and I'm not some guru with all the answers coming from an infallible theory.
I never know the way therapy will turn out. If I did know, I would be arrogant and a terrible therapist.
Just my 2 cents....
I hope I have not offended anyone.
I've been in the client chair for ten years. Now that I'm on the other side and I've had almost three years of grad-school I can see why my therapists did not point out certain things to me at certain times. There were times I was not ready to let go of a coping mechanism. I was surviving using that maladaptive coping mechanism. If the therapist were to make me aware of it and take it away from me too soon without helping me find a new coping mechanism I don't know that I'd be writing these sentences....
So, I hope that I have not come across as some "know it all." After all, I've been at this only three-ish years. It takes at least a decade to become more sophisticated. And the good therapists I know tell me that they still have doubts about their abilities.
Simcha
Posted by messadivoce on December 6, 2004, at 0:16:37
In reply to Re: simcha, posted by simcha on December 5, 2004, at 23:46:41
Hi Simcha,
I liked your reply. However, I'm not sure all T's like it when clients research on the internet. I know that I did a bunch of internet research and when I told my T, he rolled his eyes (because he was afraid of all the wacky info I might find). I found his response kind of annoying b/c I felt like he had put me in the position of ignorance and I had to fend for myself.
I know that I had a bunch of maladaptive coping mechanisms, and when my T pointed some of them out, it was really rough. But I was glad he did so...it helped jolt me out of the mediocrity I was in. But that's just me, I know that a lot of people handle things differently.
Honestly, I've always been a huge advocate for consumer's rights, so that's kind of where I'm coming from. I guess I figure if I'm thoughtful enough to want true, deep answers about my treatment, I should get them. But again, I admit that may not be right for everyone in their treatment situations.
It's interesting to hear someone's point of view who is a T. And I liked what you said about the discipline being in adolesence. I had never thought of that.
Posted by dawnfawn on December 6, 2004, at 6:36:30
In reply to Re: simcha, posted by messadivoce on December 6, 2004, at 0:16:37
I have been following this thread and I would like to say just a few words: Let's look at mental illness the way all the Ts currently say we should. It is an illness not something to be ashamed of but something to work out with medicine or talk therapy. Ok, everyone, got it. It is not like in the dark early days a secret only attended to by shaman like people who hold the solution to secrets in their own brains and methods. Well now if that is true---why should any of us as clients, patients, etc. have to undergo arcane approaches that further generate fear and misunderstanding? Put another way would you consistently wait and wait for a dentist (or any other type of doctor)? Would you wait while the doctor went over notes for ten or fifteen minutes to see what he/she was doing. Would you undergo a procedure that you were told nothing about to clean your teeth? Better yet would you not even know that you were having your teeth cleaned? Would you take medication without knowing its true effects or if it even worked? There are further analogies here but we all get the picture. The day of the mystical all-knowing father figure (Freud, Jung, etc)are long gone. Some of the stranger elements in therapy really need revision and patient input. Unless the patient has no grip on reality (psychotic) then input into treatment and methodology should really be taking place.
Posted by littleone on December 6, 2004, at 14:13:16
In reply to Re: simcha, posted by messadivoce on December 6, 2004, at 0:16:37
> I know that I had a bunch of maladaptive coping mechanisms, and when my T pointed some of them out, it was really rough. But I was glad he did so...it helped jolt me out of the mediocrity I was in.
This may be true, but I think part of what you're missing in simcha's message is that timing is everything. It's possible that your T identified these maladaptive coping mechanisms very early on in the piece. But it is unlikely that he pointed them out to you in the first session. I bet he waited until you got to a stage where you were ready to be jolted. You may not have been consciously aware of this readiness, but he would pick it up from things you said/did.
If this is the case, then this is like one of the stones or trees that simcha's pointing out along the away.
Thanks for your message simcha. You articulate yourself so well.
Posted by Susan47 on December 6, 2004, at 17:41:40
In reply to Re: simcha, posted by simcha on December 5, 2004, at 23:46:41
I got as far as a therapist holding, and can't read any longer. Shite. Okay, I hurt and have to say that, don't care if I'm vilified.
Posted by Dinah on December 6, 2004, at 19:28:05
In reply to Re: simcha, posted by simcha on December 5, 2004, at 23:46:41
I think a wise therapist should probably judge disclosure on a case by case basis. My therapist could have probably saved us both a bit of grief by demystifying things a bit. He didn't respond to my tentative questions, and I was too embarassed to go further until I did tons of research. Now mind you, I probably would have done the research anyway because I don't like the idea of someone mucking about in my brain without my knowing how. :) But I picked up a lot in my internet research that still causes me shame. If my therapist had been a bit more open, perhaps some of that stuff wouldn't have found such a foothold.
I think he regrets that now. He's way more open now than he was, and he still gets irritated when I quote the anti-whatever sites.
Posted by Dinah on December 6, 2004, at 19:30:34
In reply to Re: simcha, posted by Dinah on December 6, 2004, at 19:28:05
I kept my research my biggest darkest secret of all. It was somehow way more embarassing to admit than anything in my personal life or history.
Posted by Dinah on December 6, 2004, at 19:32:34
In reply to Re: But of course, posted by Dinah on December 6, 2004, at 19:30:34
It might be a good idea for a therapist to put out feelers every once in a while to gently inquire about outside research. I'm sure I'm not the only one embarassed that my psych libary is probably bigger than my therapist's or that I subscribe to professional magazines. (He STILL doesn't know that!)
Posted by messadivoce on December 6, 2004, at 20:33:56
In reply to Oooh, that leads to a DO, posted by Dinah on December 6, 2004, at 19:32:34
Posted by simcha on December 6, 2004, at 23:32:33
In reply to Re: simcha, posted by messadivoce on December 6, 2004, at 0:16:37
Thanks for your thoughtful reply.
I actually love an educated client. When a client is searching out answers I know that they are getting better.
I think that some therapists are insecure about their expertise and think that therapy should be some sort of secret. I don't like that. Then again I come from a Holistic perspective. I'm kind of a radical in my field.
Also, seeing how some clients look up information and apply it to their own situations is very diagnostic. Hypochondriacs are easier to spot this way. Sometimes a client may diagnose themselves improperly. I tend to err on the side of client education. When I was starting therapy ten years ago I read everything I could about what I was experiencing. This helped me and my therapy.
I've had many a psychiatrist roll their eyes when I give them information about medication that they would rather that I don't know about.
Also, there are some pretty crappy sites out there about psychiatry and psychology. Generally these are infiltrated by scientologists who hate psychiatry and psychology. They call it quackery.
So, this site is actually very excellent as a source for reliable information. WebMD is another good source. NIMH has a great site too. Be careful out there. Not all that is written anywhere is true.
Also, I'm humble enough to know that I can be wrong too. So, I do make mistakes with clients and I acknowledge them. There are limits to what we know about psychology and I acknowledge this with clients. Sometimes when I don't know the therapy is about sitting in the "I don't know."
Simcha
Posted by simcha on December 6, 2004, at 23:39:48
In reply to Re: simcha, posted by Susan47 on December 6, 2004, at 17:41:40
Susan,
I'm so sorry you are hurting. I hope that I'm not offending you. I'm just trying to tell you my experience.
I'm more than willing to be wrong. I'm a trainee. I hope I never lose the willingness to be wrong. A little humility is a great therapeutic tool and a sign of a good human being, in my humble opinion.
So, please hang in there.
Also there are a lot of very bad therapists out there unfortunately. They make it more difficult for the profession to really advance. Unacknowledged mistakes fester and give us no chance to really make the profession better.
I'm sorry if I'm no comfort to you here.
Blessings,
Simcha
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