Tuesday, March 22, 2011

Working with metaphor

One of the best things about my job is that some of my clients are students working their way toward a doctorate in clinical psychology.

One of the hardest things about my job is that some of my clients are students working their way toward a doctorate in clinical psychology.

I have heard that there are therapists who don't like working with therapy students. Apparently, those clinicians don't like the fact that the student can "see what's coming," or that the student is second-guessing the therapist's interventions. I guess that this is the equivalent of driving Dale Earnhardt Jr. to the store on a Sunday afternoon. You know you're pretty good at finding your way to the store, but you wonder if Dale is questioning your technique.

As I've worked with students over the last few years, what I've come to understand is that no matter how sophisticated someone is about therapy, no matter how big their particular bag of tricks might be, helping someone change comes down to the simplest of things. Whether or not someone can point out where they are in Prochaska's stages-of-change model ends up having not much to do with whether or not any therapeutic work gets done. Like anyone else, these future psychologists come into the room after having tried to feel better on their own.

With all of my clients, whether they're studying to become therapists, dental assistants, optometrists or artists, metaphor is an important part of our work together. Metaphor cuts through all the sophisticated terms, all the tightly-held defenses. Metaphor gives us common ground, becomes a base where my client and I can meet and look at things in the same way. A powerful image will often carry through an entire therapy, from start to finish.

We work with what the client brings. So often, those images are of destruction. Words can fall short of the ability to convey how it feels to someone to be wrecked, or broken... to have their lives swept up in what feels to them like an all-consuming conflagration. If that's where we start, it's where we start.

The important part is where we finish.

Some clients are mired in a shipwreck. They're hung up on an uncharted sandbar or attacked by a terrifying serpent at the edge of the world, all hands abandoning ship, jumping into the mysteries of the freezing ocean rather than facing certain doom on board. At this point, it makes no difference whether the client can name what is happening to them. It doesn't matter if they can call it Major Depression, Moderate, Recurrent with Full Inter-episode Recovery. Their memorization of the DSM-IV codes is of no help. They're sinking. It is important to them that I see that. It is of deep and consequential meaning that I can hear the cries of the sailors as they grasp at the rail, the sea churning below. They need me to be there with them at that exact moment that it becomes clear that the ship is breaking apart.

This is when I assure them that I have survived such shipwrecks before. As the sea begins to calm, and it will, we will search together for each piece of mast, each floating deck plank, every brass fitting we can find. We'll find a calm island, we will mark its location by the stars, and we will return to it as many times as it takes to make a drydock, to hew new decking, to fashion a sturdy new mast from a tree we've felled. When my client is ready, they will make that maiden voyage. On their own.

At that point, I watch from shore. Long after they've disappeared over the horizon, a message in a corked bottle, borne by the waves, will wash up at my feet. "Told you I was in the Contemplative Stage," it will say.

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