Saturday, March 10, 2012

What's my therapist thinking?

Like every blogger everywhere, I check my "stats" once in a while, curious to see what brought people to this particular corner of the interwebs. Often, some variation on "what is my therapist thinking?" Or "does my therapist like me?" pops up. And it makes all the sense in the world.

In therapy, one of the things you do as a client is to open yourself up, often to a greater degree than you would with a close friend. Of course you'd like to know how that's being received. Coupled with the therapist's duty to make the therapy session about the client, and not about the therapist, there's a knowledge gap there that can be uncomfortable to tolerate.

While I can't purport to know what every therapist is thinking in session (yikes! No thanks!), I can tell you a little bit about how that process works for me. And, if this is well-received, I may just take a flyer on a "does my therapist like me?" post somewhere down the road. MAYBE.

One of the things I dearly love about therapy work is that it is so engaging. I can truly say that there are very few times that I'm thinking about anything but my client when I'm in the middle of a session. Distractions outside the room abound - as hard as we try to eliminate them - but my focus is on my client. If I'm tired, stressed about something in my personal life, sick... those things really do tend to melt away in session. I'm in the midst of a flow state, when I'm doing it right.

So, I'm not thinking about things outside the room. What's going on inside the room that I'm focusing on? Therapy's complicated. A good therapist is tracking all kinds of meta-communication, like body language, vocal tone, eye contact - and parsing it all in the context of that client, the depth of the relationship (new client? Long-term?), cultural differences, etc. We look for changes in the meta-communication between sessions, and especially within session - if your eyes shift at a telling moment, if I see tears welling, if your smile isn't congruent with what you're saying, I'll point that out if the time is right. But, I have to think about whether the time is right.

We listen for content, but we try not to get too wrapped up in stories. If I'm trying too hard to remember who Uncle Bob is, and why Aunt Marge is mad at him, I'm likely to lose track of the emotional content of what's happening in the room at that moment.

Have you ever seen one of those shots of a TV control room, or a NASA launch center, with all the monitors displaying different content? Yeah. It's like that.

Another thing we're paying attention to is your safety, if that's been an issue for you. We assess for risk on a number of levels. We sometimes grimace a little, internally, when you tell us that you're going to do something that we both know is not good for you. I'm not your parent, though. Autonomy is important to me. And, if you say something that really resonates with me, that makes me remember something in my life, I have to make a very quick decision about whether or not to tell you about it. Self-disclosure isn't taboo for me, but there needs to be a reason for it.

For me, above all, therapy is about acceptance. If I can't find it within myself to truly accept you, and all that you bring each week, I can't do my job. For that reason, I really do believe that some people are able to be therapists, and some aren't. When I tell you that I'm not judging you, I mean it. The day that I'm not able to do that, I'll stop doing therapy. I love the challenge of being myself within the confines of the therapy relationship. That keeps every day, every session, worthwhile for me. Paperwork, getting to and from the office, relationships with coworkers, all of that can be difficult, but it can wait for when you've left my office.

The therapy relationship is a complicated one, but at its heart are some very simple things - respect, autonomy, acceptance - and as long as I stay there and try not to work too hard, I think I'm doing my job.


  1. My favorite part of this is the second to last paragraph. If you can't accept me, you can't do your job. That illuminates the whole process-of-a-therapist for me.

    You therapist types really do amazing work. Thanks for being so awesome. The world's a lot lovelier because of you (both you all and you in particular). <3

  2. I really enjoyed reading this post. You really touched on a lot of things that spoke to me. Thank you.

  3. I really enjoy your blog. I've been in therapy three times with three different therapists and I have to say that the atmosphere makes a big difference in how comfortable I am. All three of my therapists were friendly and welcoming, and I was comfortable sharing with them. But I'm a lot more comfortable in my body language if I'm on a couch with a couple of pillows than in an unpadded chair with no arms. I wonder if that therapist thought that I was less open because I was physically uncomfortable--her office just felt bare and clinical. The other two had cozy settings with low light and soft seating. There are just so many variables.

  4. I liked it. I used to hate it when my old therapist used to do paper work during sessions or not listen to me, I liked him but argh! I hope my new ones better.