Counseling is not surgery that substitutes words for sharp knives. Healing in the psychologist’s office must take care not to cut. Its goal is to strengthen and enlarge wisdom, courage, and tender hearts.
The pace of the therapist’s early evaluation should not open the delicate memories and emotions too soon. First, the sufferer needs sensitive preparation to reveal the trauma, especially to himself.
The unfolding of his life story takes many pages and days to pass before the climax. Some sheets must be reviewed until every page can be understood, absorbed, and purified of guilt. Tempos vary. In most cases, unresolved trauma is a matter of inches of progress and weeks when progress lives on life support, the therapist’s support, and hope.
With skill and patience, questioning a brave patient will gradually unveil what is required. The secrets are like a set of nesting dolls, one inside the next inside the next inside the next. Too rapid a revelation, and the client often takes flight.
The degree of change is not easily counted, measured, weighed, and secured. Sometimes, those who sprint from therapy’s starting line slow down, run out of breath, and fall back. Sometimes, like the story of the tortoise and the hare, slow and steady wins the race
Ecclesiastes: 9:11, from the Hebrew Bible, offers this commentary:
I have seen something else under the sun:
The race is not to the swift
or the battle to the strong,
nor does food come to the wise
or wealth to the brilliant
or favor to the learned;
but time and chance happen to them all.
As this Old Testament verse suggests, there are no guarantees in dealing with psychological trauma. In this way, I suppose, therapy requires something a bit like the faith in an all-good, all-knowing caretaker.
Therapists are not omnipotent, but at their best, they are sensitive, wise, knowledgeable, and experienced. And yet, in the treatment of desperately damaged people, they also require your belief.
Transformation is possible. Then, if the patient’s life story is reread, flipping each page will be like turning over a new leaf.
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Both photos are the work of Laura Hedien, with her kind permission: Laura Hedien Official Website.
The first is a Wisconsin Sunflare in Ottawa State Park in 2022. The second is A Lonely but Colorful Chicago Bridge.
The gradual, the unfolding. The care of tender hearts. Without guarantees, requiring bravery in the unveiling. Thank you for all of this, Dr. Stein. Some hold perceptions (and/or hopes) of therapy being directed and outcomes-focused, running counter, I believe, to good practice. “Tempos vary”. Yes, yes.
Thank you, Vicki. Certainly one must tailor the treatment to the individual, whether one uses CBT or a more free-form psychodynamic practice. Everything depends…
Thank you. Agree!
Your thoughtful essay makes me think of all change – it seems that slow and steady often is better in many ways. For me, it was starting a meditation practice that made such a difference in my life, and yet at the outset and for many months, there wasn’t anything perceptible happening but in the long wrong, beautiful things have emerged. Thank you for a great post, Dr. Stein!
You are welcome, Wynne. Yes, meditation takes its own time. I had much the same experience with it that you describe. It has become essential for me.
Do you see that expectations have changed Dr. Stein? Serving folks by listening and seeking with them has been your focus for long enough that I wonder if you have seen client focus change- seeing a need more recently for quicker resolution, easy answers, a desire to work less toward a goal of wellness?
Instant answers or instant gratification is everywhere. I see it carry over to all aspects of life. Your post brings to mind that expectations of wellness have changed dramatically and the perhaps the belief that manifests from clients is much like the analogy that we simply pop a pill as we would for a headache and the problem will magically disappear…? Simplified of course, but plausible perhaps?
Well, I’ve been retired for a while, Deb, so I am not as close to the action these days. What I can say, however, is that the helping professions are under great pressure — from patients, from their employers, and from insurance companies. From what I hear, this creates impatience, even it isn’t always because of the patients.
When I was a boy, my mother could shop for food at the neighborhood grocery. Now, people must travel farther and go to more than one store in order to find the products they want. Trips to downtown Chicago take more time, as does commuting to work via bus or car on crowded streets. The impatience seems to extend beyond the therapy room into society at large. Life has become more pressed and more complex.
Scientific innovation may have outrun our ability to adapt to it as needed. Medical specialization, the accumulation of new knowledge, a lack of a sufficient number of MDs and therapists, and time pressure has reduced the ability for a single physician to take care of whatever we need.
MDs are overworked and have less time to create anything like a team approach to the patient. As a friend who is also a retired pediatrician said to me last year, “They (the medical professionals) are not ready for us (the aging population who are doing reasonably well, but have numerous conditions related to aging that make every person of my age a new challenge because of the interaction between the various conditions and the multiple medications they must take).”
Thank you for this insightful reply Dr. Stein. Your first paragraph resonated completely with me and my personal decision to retire early given the dramatic changes my healthcare employer was implementing. While I could easily do what they asked, I did not want to as I knew it was compromising the care I would be giving to my patients. Speed equals money and numbers mattered more than patient care.
I know there are no easy answers to where our healthcare systems are positioned now, nor to where society seems to be positioning itself in general. It sounds cliche in many ways, and probably signifies my own aging POV when I sit and ponder things like this and wistfully look back on what seemed to be a much easier, calmer, gentler life that we are now so far removed from. I appreciate the chat this morning!
In the world where I grew up, to receive psycho-therapeutic treatment was a social stigma, reserved for “mad people” who were placed into asylums or “mad houses.” We the people managed our traumas and neuroses as best we could. I found help through my faith in a power greater than myself and in self-help books. In these modern days of the Internet, blogs like yours and Tamara are great resources. How different our lives as a family could’ve been if our mother had gotten the therapeutic help she needed to heal her traumas!
Thank you, Rosaliene. Indeed, our country remains blessed compared to most of the world, though our life expectancy is poor compared to that of many less prosperous countries. Income inequality kills indirectly. As to your mom, the stigma and hesitation haven’t vanished even here. The human race is sometimes its own worst enemy.
We are, indeed, our own worst enemy.
Thank you Rosaleine for mentioning me, I’m honored. What you say is so true, therapy was seen as something only the crazy people got, while the rest of the population struggled on. In my mother’s time, the psychiatric hospital in Montreal was known for doing strange and terrible experiments on the patients and this was happening in other cities too, so by word of mouth people hid all their traumas, for fear of being sent to one of those places.
As we now know, shoving traumas deep down only hurts people so much more, but they did the best they could, given what was available to them at the time. Thankfully, we have so many more resources available to us now. We can find help in many places, healing each trauma slowly as we learn new skills and get more help.
Validation is tremendously healing, and that is something that has come into our consciousness in the past decade or two. Just being able to speak about past traumas and not get negatively labeled is huge, and not to be discounted. Talking about what we went though is a two-fold blessing, for it helps us, and it also helps others who are a couple of steps behind us and who need to have a beacon to show them the path to healing and even to learn it is possible! What you are doing is vitally important too, for telling other people’s stories helps us see how other’s were able to push through their struggles to accomplish amazing things.
Tamara, it has been a blessing that we, at least here in the USA, talk more openly about mental health issues. The stigma still remains, but we have made much progress. In my post on Sunday, August 27, I share my mother’s story. I lament that she did not get the help she needed to heal from her trauma.
Yes, there are and were so many people who never received the help they needed. Thankfully that is starting to change now. We’re in a position of helping people come to those decisions too, for as we write we can offer the support and the encouragement to seek help. Looking forward to reading your post!
I was fortunate when my Dr referred me to a psychiatrist who was also a psychodynamic therapist. He became my meds Dr in 2000. We did a few stints of therapy but I was unable to open up. Until my father died. It then took two years for us to build a safe trusting therapeutic relationship. Only then did I become open and vulnerable and start talking. We just passed the eight year mark of therapy because the more we explored it became apparent my father was extremely controlling, verbally and emotionally abusive. Then many horrific nightmares. We realized together I was sexually abused for a number of years. Each of these revelations were like being hit by a truck. The time for discovery, acceptance and the fallout took many sessions. We could have quit but then I would not heal. My therapist is the first person I have ever trusted or felt safe with! Despite how frightening this last phase is we are both determined to achieve it. I have been changing as we work and the future has hope and happiness for me.
It sounds very much like the type of therapy you have received is well tailored for you, Patty. Thanks for describing it the way you did. I treated a number of patients who had been in and out of counseling over many years until, finally, they circumstances of their life combined with the right counselor and the right form of treatment. Continued courage, bravery, and progress to you.
Thank you for sharing your story, Patty. May you find healing along this painful journey <3