iPhone app iPad app Android phone app Android tablet app More

Featuring fresh takes and real-time analysis from HuffPost's signature lineup of contributors
Jane Shure

GET UPDATES FROM Jane Shure
 

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.

 

Follow Jane Shure on Twitter: www.twitter.com/http://twitter.

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 Merk...
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 Merk...
 
 
  • Comments
  • 11
  • Pending Comments
  • 0
  • View FAQ
Comments are closed for this entry
View All
Favorites
Recency  | 
Popularity
photo
HUFFPOST SUPER USER
Zuzette
05:21 PM on 08/16/2010
Several commenters mentioned very long term experiences with therapist, 10 yrs., 20 yrs. Good heavens! If you & your therapist are not making progress &/or you're not clicking with him or her, shop around until you find the right one. You'll know it when you do.
photo
HUFFPOST SUPER USER
JudeLaure
04:23 PM on 08/15/2010
Oh and by the way, Sheldon Kopp's "If You Meet the Buddha on the Road, Kill Him" really helped me understand the therapeutic relationship.
photo
HUFFPOST SUPER USER
JudeLaure
04:21 PM on 08/15/2010
I've seen quite a few therapists, all of whom subscribed to the "I don't share anything of myself" mode. I was put off by that unbalanced power dynamic and in all those cases walked away feeling uneasy and no better than when i started. Two years ago, in the midst of an emotional crisis, I found my current therapist who thank goodness, is not that Freudian, standoffish, analyst and have made great strides in really coping with all my baggage. And I'm certain most of that is because she shares, without crossing boundaries, her own experiences that parallel my own and 1) makes it clear that she is as flawed as I am, 2) no cure-all guru that can fix me and 3) a human being on a journey in search of meaning as I am.
photo
HUFFPOST SUPER USER
juna
Golden Rule is all we need.
03:26 PM on 08/13/2010
Yes, the mystery, the secrecy of the therapist can at first seem fascinating. Later, at least for me, it became annoying. Here I was revealing my innermost thoughts and feelings to a virtual stranger who didn't even meet me one tiny fraction of the way in the sharing of feelings. The coldness was offputting. And then there was the nodding off. To make a very, very, long story short, I quit therapy for good after ten years. Yes, I did receive some benefits, I would say in the first two or three years, mainly. The therapist tried to force me to stay by turning our therapy group (which I attended once a week in addition to individual therapy) against me. He also thought I was demonizing him. This was not the case, however. I didn't know enough about him, his feelings, his reasons, to demonize. In the end I had to just let go and do what was right for me.
shuffleoff
...but not to buffalo!
10:57 AM on 08/13/2010
A person close to me used to call my therapist "my rent-a-friend!" Thought the whole therapy thing was bogus. It sort of proved to be true...after 20 years, she became ill, which I felt so badly about. She tossed around coming back to work for a year and in the end decided she wasn't coming back. I found out from someone that she actually did begin to practice again. Made me feel horrible that she sort of dumped me without explaination! Tried calling to at least get a referral from her and no call back. We didn't end on a bad note, but I got the feeling that when she was ill and when I was concerned for her, it crossed some sort of line and made her uncomfortable. Or, maybe she just got tired of me! In any case, between therapist/patient, honesty is always best. Now I'm left wondering what happened...and after 20 years, there was a bond...how can there not be?? Now I'm just anti-therapy.
photo
HUFFPOST SUPER USER
wallyone
09:51 AM on 08/13/2010
How about some feedback from patients to determine which methods of therapy are successful in improving their lives? Statistical proof would be nice. Also would be nice to know the probability that certain "symptoms" lead necessarily to specific diagnoses. So many of the accepted concepts in therapy are derived from someone's opinion, sometimes well reasoned, but in the end not supported by empirical evidence. This lack of rigor has resulted in many harmful therapies that made patients worse, although that is hard for a profession devoted to healing to accept.
This is my lay opinion.
HUFFPOST SUPER USER
seajewel
09:19 AM on 08/13/2010
Of all things therapy must be one of the hardest to shop for. The hierarchy is one where you go in blindly and pay usually at least $100 if not double that to take it for a spin and you need several sessions to get know your therapist, at the same time the patient is no doubt suffering from some emotional problems which makes it even harder to make an wisely informed decision and even then you do not know anything about your therapist or their deeper beliefs, or what road they will lead you down. It takes an inordinate amount of trust in a complete stranger, which I find a little very unhealthy and imbalanced considering "the buyer beware" is the motto in our society.

It's all in good faith, but not everyone is worthy of our time, money and faith. It has to be earned or proven over time. The vulnerable position I find therapy puts upon ones patients I find very disturbing. As if they are already not looking out for your best interests. I read the labels on everything I eat, the fact that you really cannot know anything about your therapist, who you are about to divulge your deepest feelings with, is paradoxically exploitive.
08:04 AM on 08/13/2010
Hear, Here!!! There is a need, an imperative for a 'mutuality' that has been subsumed by the medical establishment. Two people sitting across from each other communicating can have a very powerful healing effect.
A good tome for all therapist is "Power in the Helping Professions" (Guggenbuhl-Craig)
This user has chosen to opt out of the Badges program
photo
09:59 PM on 08/13/2010
I fully support this recommendation along with the work of James Hillman and Thomas Moore. The relationship may be healing, however the client/patient ultimately determines the effectiveness of therapy by initiating changes in his/her life.
09:16 PM on 08/14/2010
The client is the only one who has his/her answers, A good therapist asks the right questions to help the client find his/her own answers.