This is a personal account of the journey from one side of the couch to the other and back again. It has nothing other than its face validity. I make no claims for its universality. It is not easy to be a therapist in therapy. It is not easy to be the therapist of the therapist in therapy.
It had not been part of my plan for last year to find myself needing to seek therapy; the event, which precipitated the search, was both banal and brutal. My body wasn’t hurt, but my mind was.
Much as I tried to find ways to reset my internal sense of safety and well being, I rapidly became exhausted and so did my friends. The telling and re-telling of the story, particularly when it has no resolution in sight, wears thin the tolerance of even loved-ones and intimates. They wanted the old self back, not this one whose focus and pre-occupations with hurt and anger takes away from enjoyment, and true living. They had moved on, while I hadn’t. Professional friends urged me to seek help, appealing to the remaining vestige of my own professionalism; if this were my client what would I suggest?
Beginning the search confronted me with difficulty; to whom could I go who came recommended, but was not known to me? In a smallish community of (psychologist/psychotherapy) professionals, most of those who have acquired a good reputation will bump into each other at some point, at seminars or training workshops. Going further afield meant moving into the medical model; a psychiatrist whose orientation was psychotherapy was suggested to me. I felt it was unlikely that I would be sitting next to a client, colleague or ex-client in his waiting room, so I booked in. Looking back, I now find myself questioning the fear I had to be seen as a client, whilst feeling that it deepens the compassion and respect I have for my clients.
Even the act of booking an appointment can be a confirming or disconcerting experience. On the one hand, a relief that the problem will be shared, my emotional burden shouldered by another as well as myself, presumably in an atmosphere of trust and acceptance. On the other, a reluctant admitting to myself that I could not, at this time find my way out of the distressing maze into which I had, it seemed, fallen. It has been my experience that people, who highly value their independence and autonomy, find, in the seeking of help a sense of personal failure. Despite the reassurance that I would give a client in this situation, I found it hard to convince myself that it was indeed OK to ask for help. It seemed that all my previous ability to self-validate had been swept away by the drama I had gone through, leaving me desperately needy, and simultaneously angry that I was so. To return, to regress, to a phenomenological position of requiring another’s validation was galling, to need the validation of a professional stranger, even more so. Yet, that was reality. I was therefore not an easy client.
I was critical, emotional, at times a fly on the wall, at times a demanding child. I swung wildly between equal and inferior, sometimes superior. I required him to have an ability to be flexible; the same ability that I demand of myself. And inevitably, he didn’t have it. Perhaps it is vital that ultimately, we disappoint our clients. This was a voyage of discovery, undertaken, not for the purpose of training, or curiosity, as had been most of my previous excursions into therapy. This was a necessity; part of me felt broken. I felt a vulnerability I had not often had before, with an intensity that was at times overwhelming and crippling.
I became aware, as I anticipated that first session, of the enormity of trust a client places in the therapist, and what courage it takes to make that leap of faith. To place yourself, your mind, in the care of an unknown, whose attitudes and beliefs may be at odds with your own, whose experience may be significantly different to yours. To trust that this strange person is competent and caring in their treatment of you and to ask for and accept their assistance, when you have no idea what kind of assistance they might offer. This is not like knee reconstruction surgery. There is no textbook theory into which this condition fits. The situation that created it had lurched into the abyss of litigation, and there were few reality bites. What I needed for certainty could only be obtained through the lengthy and tortuous process of subpoenas and until then I had to find my own sense, and try to discover what particular meaning the event, which had obviously been traumatic, had in my life. I wanted this therapist to help me find the story that allowed me to understand and move past my present injury, but I didn’t want it to be his story, I wanted it to be mine. I didn’t know if this therapist would be willing to walk beside me in this process, or whether he would insist on my taking his path.
Would I, having waited several weeks for this appointment, have the courage to walk out of it, should this psychiatrist turn out not to be the empathic professional he was reputed to be? Or would I just accept him, regardless of whether his approach and methodology suited my needs? Would I rationalise that I was in no position to assess the ‘fit’ between what I wanted and what I needed; or between my conscious neediness and his degree of skill? Simply, would I stick with him rather than ‘therapist shop’? I found myself in a state of confusion, in his waiting room; partly wishing I wasn’t there, partly feeling the kind of nervousness associated with serious exams, wondering if the feeling would go away if I consulted one of pile of last year’s women’s magazines, discovering it didn’t and wanting to throw up.
He was a kind, slightly portly, serious looking, typical doctor. He ushered me into his office and gestured to one of two comfortable chairs. There was also a couch on one side of the room, and a desk. For one moment I thought he was going to sit in the other chair; instead he took up residence on the other side of the desk, and proceeded to open a folder. Our sessions were conducted with him barricaded in this fashion, behind the desk, his notepad and his frequent note taking. It is a challenge to rapport development to take notes. It is impossible for the client to be unaware of the fervent scribbling, and I found myself attempting to alter the speed of speaking to accommodate the writer. I found myself trying to read what he had written, upside down. I wondered about why ‘this’ had been written down, whereas ’that’ hadn’t. I wished he would stop, and attempt to really listen. I didn’t ask him to stop, however, this was clearly his territory, and if I had entered it, then I had to accept his rules. The very vulnerability, which had led me here, interfered with my being assertive, or requesting a change in the process.
I was struck by how much work I did to get into rapport with him, and how little he seemed to do to get into rapport with me. Every time my natural shift into rapport occurred, I wondered if this was simply my attempt to please. I found myself with a dual description of the process; the view from his side of the desk, and the view from mine. Then there was the third position, from which both sides of the dance were seen. I wanted him to appreciate my expertise, yet my vulnerability got in the way. I wanted him to lead; yet where he went seemed stilted and orthodox. I wanted someone who empathised with the new territory in which I found myself. I did not want someone who thought they had standard answers. I found myself dreading the sessions, and then questioning if this was somehow an indication or confirmation of their value. There were times when I needed the session, and times when it happened because it was booked. There was ambivalence between us. I could not accept that I was his patient. Rather, I was an impatient. He blew it when it appeared on one occasion that he could not remember what he had said the previous time, and on another, when my tears and distress were answered by the suggestion of anti-depressants. It was then that I realised his mission was to prevent intense feelings, rather than have me learn to be with them, or find my own meaning in them.
I have no doubt he acted professionally or with caring. I have equally no doubt that analysis and interpretation are of very limited value for those who seek to re-write their own history or find meaning for themselves. After trauma, which by definition involves disempowerment, healing requires the finding again of personal power. What I found in my psychiatrist was his power, not mine. When I left the therapy, I felt as though I had ingested something that did not entirely belong to me. I had had enough of analytic, cognitive explanations. I could talk my way out of this, and explain it better than anyone else. Whilst I have no doubt that my hip bone’s connected to my thighbone, and that like everyone else’s, my emotional vulnerability is as raw as the day it happened, I knew that down this path lay only more of the same dogma. Belief systems are very powerful. Undoubtedly they underlie our actions, our thoughts, and our interactions. In his belief system, my on-going sense of vulnerability was not to do with what I believed, but rather to do with his theoretical assumptions about my personality. He knew better than I did, and was anxious that I should accept this. And yet still I had no real relief from the underlying feelings of vulnerability, the periodic panic and the sense of disorientation.
Six months later, I sought help from one of my own kind. This time I saw another psychologist. One whose orientation was Milton Erikson style hypnosis. It was an interesting contrast. This time I had a person who declared himself at the outset an equal, and acknowledged the difficulty of working with a peer. Perhaps psychiatrists have no peers. In my experience, there was a fundamental difference. In one the presupposition was of conscious attention and analysis, in the other an assumption that the unconscious process was the work. In the one there was attention to the words, the meaning and the narrative. In the other, I could be blissfully unaware. Shock, horror. How could a therapist be blissfully unaware? Surely we should always know what was going on?
In the quest to find this ‘other’ kind of therapist, I had made a pact with myself that I would not try to out-therapist him, that I would reserve my observations for later. It seemed senseless to be both client and critic at the same time. I decided to allow the process, with no critique or comment until after the sessions were over. He too had a standard approach. His therapy was time limited; after the initial session, he would see me four times. Whilst accepting that I might need another session if the litigation proceeded to court, our contract was clear. His aim was to assist me to gain a separation from the traumatic state, by re-accessing resource states as well as building new specific ones. Theoretically he was presuming that in the absence of the actual trauma in the present, I was collapsing into a regressed state, based upon previous experiences of infantile powerlessness. In this framework, perhaps not so different from the psychiatric model, the work of therapy was to re-form the earlier experience and place it in a safe context that was unavailable at the time. His assumption was that had I been able to do this consciously, I would have already done so. Hence the need for trance work. I could comment; I could note that his use of personal stories was at times inappropriate, that he missed opportunities for a powerful suggestion, or that his technique relied heavily on my willingness to ‘go with it’. Yet I looked forward to those sessions. I knew that even if my tears flowed in the depths of a memory, which I couldn’t quite recall once out of the Trance State, I would nonetheless feel good as I walked down the street out of his office.
It is now, another six months later. Time enough for both healing and reflection. I am left with an overwhelming sense of the power relationship in therapy, and that t he ecological use of that power is both subtle and difficult. At every turn, the therapist must make decisions about how to use that power. To be without direction may create or magnify the client’s anxiety about being adrift in the chaos of their emotions, to be directive may remove from him or her the growth that comes from confronting or acknowledging fear. This use of therapeutic power exists outside of normal requirements for successful therapy, such as caring or empathy. Both my therapists would be seen as caring, sensitive and empathic; both were as anxious to be of help, as I was to receive it. It was my perception that the psychiatrist believed he knew what would make me feel whole again, the psychologist believed he didn’t and assumed that I alone had that power. In a curious psychological paradox, I believe that I could not allow the former to have that power without reinforcing the powerlessness that had undone me in the first place.
As always, there are therapeutic ingredients which are almost missed in their simplicity. So it was for me. I cannot allow the above account to stand without acknowledgement of the on-going dialogue created between myself and two special people via e-mail during this time, both offering different, loving, immediate and genuine responses to my distress, my pain and my rage. Within the whirlpool, I felt I was not alone. Perhaps we created e-mail therapy.
[Hilary Tupling is a therapist working in Sydney, Australia.]