Therapy – the last thing you want to do?
Surely, almost no-one enjoys coming to therapy. Sometimes there is a real fear that if I talk about something, it will make it bigger, it will make it unbearable, overwhelming. Wouldn’t it be better to talk it over with a friend, with ….. well, I don’t know. Or can’t I just move on (what a favourite phrase!)? Be positive, cheer up, count my blessings (and so on and so on)? It’s a bit depressing talking about … whatever. If I read a book; if … well, maybe I will go to the doctor. 7.3 million people in the UK are on antidepressants, 7.3 million: one in six of the adult population. When 50,000 watch Man United, 8,000 are on Prozac (or its equivalent). Coming to a first session is really hard – people just don’t want to do it. By the way, less than 730, 000 are in therapy in the UK – less than a tenth of those on medication. What does that say? And to have to pay for therapy, pay for every session – no wonder people want it sorted quickly. There must be a better way, an easier way, a cheaper way?
Different therapies
Sorry, this is the boring bit. Just like there are different religions, there are different sorts of therapy. There is CBT (Cognitive…) and there is psychodynamic (yes there are others, but they are two of the big players). CBT is solution focussed; it offers a toolbox of skills; it is generally short term, 6 to 20 sessions; it does not open up too much. Many people find it useful, some are passionate about it – the NHS is for one.
I am not going to write about others mainly because I haven’t got experience of them. Nor am I going to write here about how to choose, well not yet anyway.
What happens in therapy?
I am writing about psychodynamic – yes I know it is a jargon word. In a future blog I will talk about the ‘dynamic’ bit. So, what happens in psychodynamic? Easy, I ask how someone is and I wait and listen. I know, people say that whenever you are asked how you are, you say ‘Fine’, so no I don’t always ask it, but that is what I am wondering. And then I leave a space.
Everyone’s different
OK, this sounds stupid, but ‘I leave a space’ isn’t totally true. Some people can tolerate a space and some can’t. I believe how we are, who we are goes back hugely to how we have been formed. People coming to therapy are saying ‘Something is wrong’. One of the things that may be ‘wrong’ is that there was too much space growing up. Healthy babies (I believe) need to know that someone is there; that when they reach out someone will welcome it and celebrate it and smile and affirm it. Reaching out is scary, you don’t know what will happen if you reach out. I mean physically – reaching out an arm, reaching out a leg or a toe. But I mean reaching out emotionally too – crying, being angry, smiling: that someone will be there to receive that and love it and return it.
Of course mothers can’t do that all the time [when i say ‘mother’, I mean the person who mothers, it is not a gender thing as far as I know]. But mothers hopefully do it often enough, they are ‘good enough’ mothers. Mothers get it wrong and then they repair. Rupture, and repair.
So in therapy, I do leave a space. But I try to be aware that a space can be really unhelpful, frightening for some people.
Listening
I try to listen. What do I listen for? OK, I listen to what people are saying – words, sentences, issues, problems, difficulties. But at another level I am trying to hear and wonder, what is going on? What is the person saying, what is important to them, how are they as a person, who are they?
You could say that I listen for their feelings. It sounds so obvious. Someone can tell a whole story and I can get hooked into the story – but why are they telling it? What are they making me feel, what do they feel? And the feelings are not the obvious ones necessarily. Some can tell a shocking story, but they can tell it in a cold dead way; in a triumphant way; in a distracted way; in a heartbroken way; in a vague way; and more, far more.
The client has come, and there is a reason for them coming. I don’t know the reason, they may well not know. Often their feelings are mixed, often they have feelings they don’t want to have; very often the feelings are not on the surface – they pop out. As a therapist you think you hear something. Sometimes you say what you think you have heard out loud. Often the client says “No, not at all”; and so you wait and listen more.
The client has come, so part of them wants to be heard. Part of them is thinking about committing to trusting a little (other parts may be unconsciously hostile); so some of the work is an exploration together. As therapist I want to hear (let’s talk another time about areas of a therapist that they have not worked through, where they find it harder to hear clearly). As a client part of you wants to be heard (and part of you does not – defences are often strong, precious, valuable). So therapy at its best is a journey together.
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