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Jane Shure

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Reflections on the Doctor Patient Hierarchy in Psychotherapy

Posted: 08/13/10 08:00 AM ET

It's complicated. The relationship between a therapist and patient -- it's really complicated, as is the journey to healing our childhood wounds. Last week, in the New York Times Magazine, Daphne Merkin self-disclosed of her life in therapy, opening us to a much needed public dialogue.

What helps one person deal with their inner life may not be effective for another person. We do not conform to cookie cutter categories -- we're diverse. Such is the case when one considers the best way to approach psychotherapy. There isn't only one way to do it and there isn't necessarily a "best" way. Certainly, the field has evolved significantly over the second half of the last century, providing ample evidence that there are many ways to achieve deep levels of change and increase satisfaction in the life one lives.

Merkin's article reminds me of how the psychoanalytic approach to healing "neurosis" and other "maladies" of the psyche can be limiting and risk leaving patients more vulnerable to having the self disregarded, even rejected. Steeped in the belief of therapist neutrality and the need for relational distance, the traditional model doesn't hold up for most of us living in the twenty-first century.

Far beyond the issue of "who has the time or money required for several days of analytic treatment," is the recognition that people change within the context of feeling connected to a real person and when they have experiences that challenge their belief systems. I was disheartened to read that the author was never told about her therapist's cancer, thereby never able to say goodbye or get any sense of "closure," and disturbed to know that she was never given permission to leave therapy. These actions are certainly not unique to those practicing in the analytic tradition, but they are more common in the hierarchical structure of the analyst-patient relationship.

I remember years ago having lunch with a good friend who revealed how strange and off-putting he found his former therapist's unwillingness to share anything about herself, such as where she was going on vacation. I was struck by the irony of how the distance maintained by the therapist created a sense of alienation rather than one of connection, and wondered why that type of therapeutic approach continued to be promoted in psychotherapy training at the time. For me, it was one of many moments in my professional development when I paused to take in the feedback from a person in the patient position, feedback that has often been discrepant from the feedback given by those of us in the so-called "expert" position. We've come a long way since those days close to 20 years ago, but reading Merkin's article, I'm saddened to say, reminds me of how much further we have to go.

I believe it's authenticity that heals us. When we can be ourselves, supportive of our strengths, and accepting of our shortcomings, we grow in self-confidence, engage in more healthy relationships, and overall, feel better about ourselves. As a therapist, I've had to seek coming to know my own authentic self, questioning the rules and wisdom passed down from one generation to another.

It continues to be time for all of us to reevaluate traditional models of psychotherapy, and continue to update our understanding of what promotes emotional healing, resilience and interdependency in relationships. We all need to do so -- therapist, patient, parent and anyone else interested in promoting a sense of greater well-being in children and adults.

For more, see my website.

 

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