Monday, September 29, 2008

Freud warned that all cases suffer from being explained

My supervisor recently lent me the book, A Safe Place by Lester Havens. I am finding so many passages from this book that fill me with a sense of relief. The common pattern between all of these passages so far is that they talk about the behind the scenes interaction of the therapist and patient. For instance, Havens suggests that "as long as therapists depend upon patient's accounts of their problems, we are in danger of seeing things the way the patients do." He goes on to describe how really demanding people rarely view themselves as demanding: they feel entitle to what they receive, and perhaps expect more. Another example is perhaps that shy people seldom see themselves as being shy, instead they worry about being an oppressive force on others. My first reaction to this was, "of course!" However, I have rarely thought of interpreting a clients presentation to me in this way consciously. In thinking about someone describing themselves as a modest, shy, or demanding in a session, I can see how one way to react would be to merely acknowledge the lack of insight they seem to have to their situation and fit their dysfunctional thought patterns into a model that explains the err of their ways, however I also see that there is a skill that comes from being able to recognize the discrepancy, listen for similar associations, and formulate ways of interacting with the patient that may allow them the freedom to determine, for themselves, how they recover what they may have lost, or even define something new.

I believe that any decent therapist incorporates the second, more psychodynamic approach, when interacting with a client, but it is not something that was discussed in my CBT-oriented program. It all makes good sense and perhaps others don't need to see the words written out on the page like I do, however my interpretation of the absence of being taught the basics of therapist-client interaction was that it just was not important to delivering CBT. Perhaps it was just my expectations of what my clinical training would be like and the type of intellectual conversations that we would have in our coursework, but I feel grossly unprepared to describe the skill that I have learned in conducting therapy outside of my ability to follow a manual.

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