Learning “The Tricks of the Trade”: How a Therapist Gains Confidence

Therapists are born with the capacity to become confident but have only that possibility when they begin seeing patients as a part of their training. The trainees watch videos of their work, listen to changes in their voice, and observe their own body language, as well as a client’s movements, subtle changes of expression, and tone of voice. These budding psychologists receive guidance regarding when to speak, when to remain quiet, and whether a topic is ripe for attention or still too tender to touch.

Any and all of these considerations play a part in how the treatment process moves forward, if indeed it progresses at all.

Learning your craft is painstaking and painful. Your supervisors describe every weakness and strength. They should. The best of them challenge you to make yourself into what you must become to serve your clients. Your human flaws are dissected and examined. Left untreated, the new professional will inflict them onto and into the people he promised to care for.

It isn’t easy. It shouldn’t be easy. But it helps you become the best you can be, someone who is worthy of trust and an individual who accumulates wisdom if it is in you to learn what the human soul consists of — the light and the dark of it.

If you are as conscientious as you should be, you will take your failures and successes home at the start of your career. Yes, a counselor must learn to keep a therapeutic distance and protect himself from complete identification with the client’s suffering. Your best work cannot cause your own emotional collapse, but you must not be indifferent.

The whole enterprise of psychotherapy is a tightrope walk.

There are no shortcuts; if you are doing your job, you must keep up with the literature in your field of expertise. You are expected to be an expert, but that requires you to grow as the body of knowledge in your area grows. No one will pay you for this; no one will applaud this. It is your responsibility.

Funny, but one of the best comments on excellence in any field comes from a famous baseball pitcher, Vernon Law:

Some people are so busy
learning the tricks of the trade
that they never learn the trade.

I recently discussed that trade with Wynne Leon and Dr. Victoria Atkinson for their podcast, Sharing the Heart of the Matter:

Episode 20: The Art of the Interview with Dr. Gerald Stein on Anchor.

During our conversation, we talked about some of the things I learned and how I came to learn them during sessions with my clients, interviewing members of the Chicago Symphony for its Oral History Project, and working as an expert witness. I also described my understanding of the human tendency to render simplistic judgments of others. Finally, Wynne Leon and Dr. Atkinson asked me about matters of the heart involving a psychiatrist I knew, Dr. Jerry Katz, and my father.

Those matters of the heart fit the focus of Sharing the Heart of the Matter.

I hope you will listen: Episode 20: The Art of the Interview with Dr. Gerald Stein on Anchor.

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The photo of A Session with a Psychotherapist is the work of Mike Renlund. It was sourced from Wikimedia Commons.

If Therapists Have Problems, How Can They Help?

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I’ve never met anyone without problems, in or out of therapy. Some are more serene, optimistic, or luckier, but no one escapes the downside of life: frustration, heartbreak, and aging. What then, despite those troubles, enables such a person — aka your therapist — to help?

Part of his capacity to relate to you is the very fact that he can’t escape either. The counselor and you are members of the same species, no matter how different in significant details. Basic experiences are common to each of you: learning, making a living, finding love, communicating in words, inhabiting a fragile body, losing people, and facing your own demise.

He is also damaged, if not necessarily as severely as you; and ideally, not suffering acutely in the moment he treats you. Yes, there is a point beyond which the one treating needs treatment before he can assist others. Perhaps his own demons are triggered by what you say or do, even how you look. Maybe he will be unreliable or poorly trained, using outmoded theories or failing to keep up with “what works.” A counselor can also be overwhelmed by his own life circumstances and lack the energy to help while he is trying to stay afloat himself.

These concerns excepted, you will still be dealing with a flawed person. Best if he is not also either too young or too old. A youthful counselor is inexperienced by definition. He brings enthusiasm, boundless effort, and (we hope) knowledge of the latest research, but hasn’t spent enough time in the trenches. Still, he must learn his craft somewhere.

Caution also applies to seasoned doctors who just go through the motions or have run out of gas. Too often they are tied to routine ways of thinking and are no longer “alive” to what it means to be in the springtime of life. They, too, should be avoided, perhaps even more than earnest young people who will, at least, invest themselves in you.

Part of my hesitation in recommending young therapists, however, has nothing to do with their limited patient contact. Rather, most have not been hurt enough. To be adequate to treat, life must have its way with us for a time. We need to find out who we are and what life is. Ideally, counselors also need a body beginning to show signs it won’t last forever — to be informed of their own mortality. A future therapist should be humbled by life and find a way to come back for more. His rebound approximates the journey you hope to make yourself, the one on which he will accompany you.

Consider the kinds of preliminary encounters the legendary conductor Bruno Walter thought necessary for making music. Imagine how his opinion applies to a therapist’s need for life experience. The language is fulsome, characteristic of the time he was born (1876), but the message transcends it:

“He who has not experienced the stormy sea with a feeling heart will fail to find the elemental force of expression essential for the Overture of Wagner’s Flying Dutchman … Beethoven’s Scene by the Brook (from the Pastoral Symphony) will sound empty unless the conductor’s own delight in a purling brook and a smiling landscape is joined to the musical soulfulness of (his) interpretation … (And) he who is a stranger to ecstasy cannot convincingly conduct Wagner’s Tristan and Isolde.”

Simply put, should you visit a shrink who lacks the education acquired by passing through times both rough and wonderful? Read Homer’s Odyssey and ask yourself how the hero, Odysseus, might have been changed by a 10-year war at Troy, returning home by sea, fighting the Cyclops, and the additional 10-years required to find his way back? Few therapists experience anything close to this, but do learn a few things down a less remarkable path.ulises

A shrink should be like The Velveteen Rabbit, who only became “real” by being worn from use and transformed by love.

Therapists and non-therapists alike are survivors. Indeed, we are all the offspring of shipwrecked fellow men who endured. A shrink without personal acquaintance with travail and romance would be like a Martian trying to understand mankind. Yes, your doc has his own “stuff.” Would you prefer a virgin psychologist, untouched by life as well as sex?

Yet, he must also be different than his patients. A professional combines his training and experience to form an understanding of the “full catastrophe*” of existence. His daily practice allows refinement of the technique required to aid others. Thus, a seasoned counselor’s personal hardships and learning meld with the experience of helping patients (from whom he also learns, especially by making the mistakes novices usually do).

The practitioner ought to know more than you do about the healing art. Moreover, he is useful because he is NOT tied to you at the deepest level. A therapeutic perspective is essential: the dilemmas of your life are yours, not his, nor those of his loved ones. He can keep his head because of this, even though he does come to care about you as a particular person with increasing contact. Therapeutic distance permits him to remain calm and thoughtful in the presence of your pain.

Perhaps, too, the shrink has been luckier than you, without which he could not lend you his hope. He knows good things can happen and the darkness is followed by the dawn, at least much of the time. You are better off for his self-assurance and clarity of mind. They enable him to see the dimly lit road out of the woods. You would not wish him to be looking for the breadcrumbs left by Hansel and Gretel.

None of this is to suggest the counselor is some sort of god. Rather, he is the master of a limited situation — the small chamber in which he does his work. He is also an illusionist, of sorts. If you observed him unshaven, in his underwear, without the mirrors and smoke, arguing with his mate, worried about his kids, upset because the newspaper delivery service keeps leaving him the Tribune instead of the New York Times, then you might think less of him.

The illusion is a necessary one. You overgeneralize and come to believe that he is a wizard everywhere and all the time. He doesn’t stop you, as if he could. You need to believe.

So, dear reader, we therapists are quite mortal. We’ve got our own issues and the bruises sustained on our part-way-completed expedition through life. If we are any good, then we are observant and sensitive. We’ve seen the world’s unfairness. Judgment is set aside for the most part. We are each, as Seinfeld’s George Costanza used to say, “master of our domain,” although in a rather different context than George intended.

Some of our imperfections enable us to help. When we have too many? That’s another story.

*The facetious phrase, “full catastrophe,” comes from the 1964 movie Zorba the Greek. It has become associated with the book Full Catastrophe Living by John Kabat-Zinn.

The first image comes from the 1954 movie Ulysses (the Roman name for Odysseus). The ship is a model, not a full-sized boat. An illusion, yes? The movie poster is from the same film. The title role was played by Kirk Douglas. Anthony Quinn portrayed “Zorba” in the 1964 movie and took a supporting role in Ulysses.