Respectful therapy

When I go to a party and someone finds out I’m a therapist, it’s not unusual to see them roll their eyes and ask in an uneasy tone, “So…I bet you’re analyzing me the whole time we’re talking, aren’t you?”

It’s easy to blame therapy’s bad public image on movies like “Analyze This” or on the evils of the managed-care system. But part of the problem is in therapy itself, and in particular the prevailing medical model for treatment.

For the most part therapists are trained to think in terms of “mental health,” “diagnosis,” and “pathology,” an orientation that does a kind of violence to the human soul.

Paradoxically, most people start therapy because they are hoping for a change, but most of us are also afraid to change. We are used to our usual ways of going about things. In fact, we’ve learned to do things the way we do for very good reasons. (The problem is that, although our usual ways may have helped us in the past, in the present they are getting in the way of the life we long for.) As the therapeutic work progresses and people naturally find it difficult to change their life patterns, therapists who think according to the medical model tend to talk in terms of the patient’s “defenses” and “resistance” and see their job as breaking through these as quickly as possible.

Happily, you can find therapists with a very different approach to people and the therapeutic process. You can’t always identify them by the letters after their names (some are even M.D.’s), but as you sit in the session you are likely to sense a respect and empathy for you as a whole person. The therapist’s focus on listening to rather than labeling the client and her or his struggles has an enormous impact on the quality of the therapeutic experience, as Jean Baker Miller and Irene Pierce Stiver of the Stone Center point out in the following excerpt from The Healing Connection.

“Probably a patient’s greatest fear in therapy is the fear of changing, of giving up those ways of feeling and acting that, although not really helpful, seemed to promise some power, some strength.

“In other words, it can be terribly difficult to give up one’s strategies for staying out of authentic connection because they are in some sense adaptive — that is, they arise when the only relationships that are available are in some fundamental way disconnecting or even destructive: at some point in a person’s history there was good reason to develop these strategies.

“Instead of labeling such behaviors in therapy as resistance, we think of them as lifesaving — or mind-saving — strategies that people have developed for a reason. Sometimes patients are saying, in effect, “No, I won’t engage with you because that means I have to turn into what you want me to be, and if I did that I would lose myself.” This stance most likely evolved as a survival maneuver. It is a strategy that makes it difficult to form a relationship in therapy, but it deserves the therapist’s respect and attention….”

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