…the therapy process – for the therapist lost – this is for her
posted on Tuesday, March 15th, 2011, 3:39am by writer723
revised from an essay written
by jan goddard-finegold
edited by maggie christian 3.15.11
a personal statement follows at the end…
In this essay I give my views on the boundaries of individual psychotherapy—the necessity and the process of learning them, accepting them, the gaining from and leaving the therapy process. For me, the learning process was long, and I realize now how I had to internalize a number of new concepts for the therapy to succeed. After much thought and work, therapy was beneficial and rewarding for me. I now know that because I took the process of psychotherapy seriously, it made my life more fulfilling and my relationships more meaningful. For me, psychotherapy was especially helpful in reinforcing my ability to deal…It helped me make each day a gift, accept my imperfections, and live with uncertainty, frustration, and anger with more dignity and greater understanding.
What we say in the world – We rarely divulge our personal thoughts in public, unless we feel a sudden sense of commonality and connection with a person or group of people.
Psychotherapy as a “safe place” and its boundaries – The freedom to speak openly and unguardedly is confidential in very circumscribed situations: with our lawyers and our physicians; with our priests, rabbis, or ministers; and most notably, with our psychotherapists (psychiatric physicians; psychiatric, clinical, and family social workers; clinical psychologists; and licensed lay psychotherapists, for the most part). The relationship between a qualified psychotherapist and a patient is a “safe place.”
Nevertheless, I learned that there are rules that govern such a therapeutic relationship, rules that must be adhered to, that have stood the test of time, and that ensure physical and mental safety, for both the therapist and the patient. While the rules, or “boundaries,” have been stated somewhat differently by various therapists, I describe them from my experience as follows: (1) The emphasis in therapy is almost exclusively on the life and thoughts of the patient; (2) The therapist concentrates on finding ways to communicate meaningfully and helpfully with the patient about his or her difficulties using examples and knowledge from the therapist’s training and experience; (3) While the personality of the therapist is paramount to his or her success in therapeutic relationships, the therapist does not share her personal life, family information or problems, and especially, identity of or information about other patients; (4) The therapist may find ways to build her patient’s self-esteem by expressing admiration or joy for her patient or her success during therapy as well as concern for her patient’s well-being. A competent psychotherapist, however, does not disclose sexual attraction or love for her patient (nor distaste or dislike of her patient). If the therapist has sexual or loving feelings for the patient, or truly dislikes a patient, referral to another therapist is the answer.
While boundaries enable the therapist to focus on her patient’s problems and issues, the strictness of boundaries is not necessarily that originally taught by Freud, ie, that the therapist show “neutrality, anonymity, and abstinence” toward her patient. The current day interpretation of Freud’s concepts of boundaries would most likely be described as “restraint” on the part of the therapist. This means that each therapist will spontaneously reveal emotional responses to the patient’s comments and, in a nonjudgmental way, will learn about, interpret, and to a helpful and honest extent, go with the flow of the patient’s internal world.
Transference and countertransference – While there are other recurring psychological responses in psychotherapy (such as resistance, repression, projection, hostility, and displacement), recognizing and dealing with transference and countertransference are major issues in psychotherapy and make the boundaries of psychotherapy most important and protective. The empathic use of boundaries by a therapist allows her to be warm and responsive to her patient, to make an environment of trust for her patient, and to allow her patient to feel validated and understood.
Transference is not usually recognized by the patient (the therapist is trained to recognize both transference and countertransference); many patients feel that they have a special (frequently loving) relationship with the therapist or that they distrust or even hate the therapist. I felt that I had a special relationship with my physician-therapist, but soon it became apparent and acceptable to me that the therapist was helping with tools that did not involve a relationship of the kind exemplified by a close bilateral friendship, despite the fact that my therapist and I were a “good fit.” I also became aware of the need I sometimes had to please my therapist as I might have attempted to please my parents; I learned that this was not a good way to make progress in my therapy.
When I became aware of the reasons my therapist did not share information about her personal life, I felt safer because this boundary was kept intact. I was not burdened with knowing her difficulties or worries in her life. In addition, the physical distance between my therapist and me in the treatment setting was always far enough that any urge to touch was avoided. Sometimes a therapist will give a patient a single touch on her shoulder (behind her patient) as her patient is leaving a particularly difficult emotional session. I think this allows the patient to feel reassured that the therapist is there for her, but I understand why hugs are, for the most part, avoided. There are circumstances in which a hug is appropriate (when a patient is in extreme distress because of a recent or unexpected death of a close friend or relative). In such cases, the reason for the hug is discussed in the therapy. Depending on the training of the therapist, handshakes may be either held back or used more commonly in psychodynamic psychotherapy practices. In general, physical contact with a patient should be done with care and forethought as to possible unwanted, or unexpected, consequences. My therapist does not give hugs or handshakes but, rather, speaks sympathetically and from her heart when unexpected emotional situations arise.
On another note, most of the time, my therapist waits for me to acknowledge our relationship in public situations to maintain doctor/patient confidentiality; I feel comfortable acknowledging her openly but unobtrusively.
The therapist’s responses to patient’s questions about personal issues – A therapist may respond to a patient’s question about her personal life with another question that brings out the patient’s inner capacity to solve problems. In this way, the therapist does not let go of personal boundaries but uses the natural inquisitiveness and interest of the patient to other ends. An example might be that the patient is interested in the therapist’s children and asks when she has time to spend with them. The therapist might answer, “Do you think this question relates to your feelings about your father’s time spent with you as a child?” Answering a question with a question such as this used to irritate me when I was new to psychotherapy. Now as a seasoned warrior, I expect such a response and I am able to predict the question.
Gratefulness for her one-sided nature of psychotherapy – After some time in therapy I became acutely aware of how special the therapeutic relationship really is. The true confidentiality became apparent. It was clear that when negative issues arose, there was time to work them out against a thinking “punching bag,” who would not wilt or show personal distress when I expressed difficult feelings. In fact, my “punching bag” therapist looked forward to such challenges, took them as meaningful outpourings from me, and used her training to help me express such feelings. Together we built a positive framework for accepting and dealing with the underlying causes of my anger, guilt, and sadness.
Realization of the goals of therapy: giving up fantasies – Psychotherapy is not an immediate cure-all. Some patients have the fantasy that a few sessions with a therapist will yield suggestions that will still the waters of distress. The process does not work this way. Others have the idea that what they say in therapy will always be accepted as correct, workable, and acceptable. Of what value would therapy be if this were true?
I have learned that there is much energy that goes into the ongoing process of psychotherapy. Certainly there are shortened forms of therapy; however, in most cases, I think that long-standing success occurs only after a long period of hard work on the part of both therapist and patient. I believe that during this work, the patient learns that the therapist will show where there is faulty or injurious thinking. Freud called this the “common work.” My therapist and I have called it our “project.” Indeed, it has been a project, one that is now ending because my therapist and I feel that the goals of our project, which we clarified throughout the therapeutic process, have been met for the most part. This achievement has left me feeling a sense of success and the ability to carry on in life using the tools gained during the interactions with my therapist. When difficult emotional situations arise, I have an arsenal of psychological armaments with which to fight.
A caring, enduring, goal-oriented relationship – While the relationship between therapist and patient is limited by boundaries, those important conditions do not mean the relationship cannot be enduring, caring, respectful, and in some sense, intimate. The therapeutic relationship involves sharing thoughts that are meaningful, sometimes filled with uncertainty, guilt, fragmentation, hatred, hope, forgiveness, fear, love, all the emotions that make us human but also that are frequently kept in our most closeted selves. The fact that I have been able to share and discuss such feelings in safety with my psychotherapist has made our therapeutic relationship work. Our project will be enduring if its effects are enduring and if I am able to use it as a lifelong, continuing, learning enterprise. Likewise, caring and respect do not have boundaries and can exist for a lifetime between patient and therapist.
Moving on – In the usual course of psychotherapy, moving on is a gradual process for the patient. However, some may choose to end therapy abruptly with total cessation of the relationship between patient and therapist (which may be harmful for the patient in the long run, as she may not be as prepared for psychological exigencies as she imagines). For others, the loss sustained by the patient during disengagement from therapy is a process in and of itself and one that has to be worked out just as other emotional issues have been conquered during therapy.
For my therapist and me, the process has been gradual. Fortunately, it has become evident that not only am I no longer depressed but also I feel a confidence in dealing with emotional issues that I did not have before therapy; thus, we have negotiated a plan to end our sessions. I am confident that over a reasonable period, there will be complete disengagement, with an understanding that my therapy could be started again, if necessary. I also feel that I will continue a process of self-reflection after my therapy has formally ended.
Further consequences of long-term psychotherapy – When two people work together to solve the problems of one of them, using the expertise, common sense, experience, and caring of the other, there will be a relationship. In individual psychotherapy, that relationship will be built on trust, knowledge, and mutual respect and will have appropriate boundaries. Nevertheless, the relationship that develops over time, limited though it is in the way the therapist shares personal information, and confidential though it is from the therapist’s point of view, is a feeling one: the therapist and patient may feel loss at the end of such individual therapy; the therapist may have sadness because of the difficulties of a patient. The same is true for the patient when a caring therapist becomes ill or dies; in fact, as a patient with depression, I had an additional burden when my first therapist died unexpectedly during my course of therapy. A relationship with boundaries is a safe relationship, but that does not mean that it does not have mutual feeling. This feeling contributed to making individual psychotherapy special, helpful, and valued by me. Also, I recognized the large repertoire of background, training, and skill on the part of my psychotherapist, and, similarly, my degree of sincerity, perseverance, and determination for success.
a statement in response to this article by maggie christian:
i felt that the person who wrote this article was channeling me from my present but it came from their past. the words written spoke my thoughts. the relationship she spoke of i lived through with some minor details that were different from the relationship i had with my therapist. i dedicate this to the therapist i lost so suddenly. unlike this writer, i did not have the chance for closure nor the option of ending the relationship. it came to an abrupt stop. there is no returning for more therapy from her. she is gone. i do highly recommend psychotherapy. it is a difficult journey through the psyche, the emotions and the soul but for some a necessary process to endure. the sharing in the therapeutic relationship goes beyond any other relationship that one can describe. it is intimate. it is painful. it is satisfying. it is enlightening. it is profound. it is meaningful. it leads to an awareness that most will not find anywhere else. my therapist led me to return to meditation, writing and the inner world of my mind, emotions, body and soul. she began to teach me how to open up and to trust again. she temporarily brought down the wall i began building since childhood. she led me to another therapist who i believe is becoming a perfect fit for me. she knew me well to know that i would make it without her physical presence there for me but i will always keep her with me in my heart, my mind and my soul. i thank her for what she gave to me and what she is still giving. the following quotations are some of those gifts she gave to me through her kindness and tenderness while teaching me. namaste! i honor the place in you in which the entire universe dwells. i honor the place in you which is of love, of truth, of light and of peace. when you are in that place in you and i am in that place in me, we are one. ~all is one..one is all~
”poetry concretizes the singular, unrepeatable moment; it hammers out of speech a form for how it feels to be oneself.” ~mark doty~
“Spiritual self-confidence fills one’s heart with a love that is not dependent on external circumstances for its fullness. It’s a love that is unshakable, unmoving, and indestructible. Such love a love that transcends yet simultaneously embraces the world is what compels human beings to evolve, from their own deepest depths, and to become better citizens of our world and our cosmos. Knowing the mysterious source of that love is knowing before thought that life is good. That inherent goodness is who we really are.” Andrew Cohen
“A feeling is fluid, it’s alive, it’s dynamic, it actually helps us when we tune into it or go deeply into it, it actually helps us connect with ourselves more deeply.” ~John Welwood~
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ~Maya Angelou~
”Life is not measured by the number of breaths we take, but by the moments that take our breath away…” ~Hilary Cooper~
”Creativity exists in the spaces between ideas”. ~David Wescott~
“Truth is, everybody is going to hurt you; you just gotta find the ones worth suffering for.” Bob Marley
Piglet: “How do you spell LOVE?” Winnie The Pooh: “You don’t spell it. You, feel it.” ~A.A. Milne~
“Love is looking at someone, and not having to say a word, not having to hide, not being in control and not being afraid.” ~anon~
“The truth of the matter is, people are always going to stay in our hearts, whether they are in our lives or not.” ~Manda~
“The best & most beautiful things in life cannot be seen, not touched, but are felt in the heart.” ~Helen Keller~