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How Conversation Sparks Therapeutic Change - Page 3

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"Rules" for Spontaneous Conversation

Follow the Spark

One true sign that you and your client are having a genuinely therapeutic conversation is that you have absolutely no idea where it's going. Most of us shy away from life's unpredictability, and we certainly do so in therapy. It's easy, then, to think: "What am I doing? Does this really have anything to do with treatment?" So, the most crucial skill to learn, the awareness that guides everything else, is recognizing that if the conversation generates a spark of interest in the client and you're learning something new--if you both feel more alive in the room--almost without question, you're onto something.

This "follow the spark" rule is an antidote to that dirty little secret we clinicians live with: how bored we can be much of the time in sessions. I believe we're often bored because we pay more attention to teaching than to learning, to directing an intervention at a client than actually conversing. We also ignore the clinical relevance of boredom--it's a signal that it's time to mix things up--trying instead to narrowly attend to what we think is the "point" of therapy. In doing so, we miss those quicksilver glints of interest flickering across faces or the slightly excited intonation that signals something important is happening, especially when the subject is outside what we consider the "real" work of treatment. Too bad--the taken-for-granted or ignored spark can be the tip of an emerging self.

So, always factoring your client's fragility and strengths into the equation, when "that look" appears on his or her face or you hear a certain tone of voice and it sparks your interest, go for it. Pursue the conversation without a clue about where it's heading. Just make sure it continues to feel alive. Follow what's compelling with concrete questions. Get into enough specific details that you could vividly describe the situation to a fictitious other, and share your own opinions, so your patient knows where you stand. Most of all, don't be afraid of heated but good-natured arguments, humor, and just plain curiosity, without any specific clinical goal in mind. You may be surprised by the dimensions and characteristics of the client's unspoken self that begin to emerge.

Vanessa is a gay woman in her mid-thirties with a history of depression. When she came to therapy, she had just one friend, was without a love relationship, and only had part-time employment. She'd barely look at me, reluctantly letting go of whatever I could pull out of her. Then in one session, she and I began to argue about sports, after I mentioned something or other about baseball and saw a glint in her eye. Regardless of how depressed Vanessa was, she'd debate every one of my sports theories with great fierceness. You'll undoubtedly understand how out of touch with reality Vanessa could be when I tell you she disagreed with my unswerving belief that the new home of the New York Mets, Citi Field, was built over the old cement parking lot of Shea Stadium (in order to save money), which clearly accounts for the numerous injuries sustained by Mets players since they moved.

Every debate of this and other sports-related insights not only engaged us both, but temporarily lifted Vanessa's mood. Then we moved on to films, which she was just as fiercely knowledgeable about as sports--you can watch a lot of Netflix while depressed. I never directly commented on how competent Vanessa was in these areas--I didn't have to. In fact it would have been patronizing. The shared intensity of our arguments signaled my respect for her views.

One day, without discussing it with me, Vanessa signed up for a community college course in cinema studies. She brought the same passion to her contributions in class that she had to her talks with me, attracting the attention and friendship of teachers and peers. Gradually, her depression lifted just enough to allow her to begin a program in film production, specifically historical documentaries about marginalized peoples. She still has periodic depressive episodes--there are few miracles in our work--but when Vanessa comes back for a check-in session, we continue to argue about sports. And for some reason, she still disagrees with me about my Shea Stadium--parking-lot theory.

Develop a Theme

In an Internet era when people's selves are so fragmented, therapy is a kind of glue for personal coherence. Developing a theme through a series of discussions helps bind the self together. The process begins when the therapist notices a flicker of interest and is open to learning more about it. Because the theme matters to the patient, it surfaces again and again, coalescing into an unspoken aspect of the self he or she can gradually own.

Jozeph, a twenty-something recovering party-animal originally from Eastern Europe, was referred to me because he'd mastered the art of passing school without ever going to a class. Once the community college he was currently toying with caught on to him, he was out on his ass. Jozeph's relationship with his parents was strained, since they'd labeled him amoral for all the acting out. Our therapy didn't focus on these concerns, however. Instead, it mostly proceeded as a series of discussions about his reaction to the rudeness he regularly encountered on the streets of New York, how he'd faced down a disruptive kid in one of his classes, or how much outrage he felt about the way his friends were able to "bullshit" their way around parental control.

To develop a theme with him that felt really alive, I asked Jozeph, as I always do, to give as much specific detail as he could for every story about his outrage or exasperation, so we could experience these situations together more fully. I always kept close watch to see whether the stories left me feeling engaged as well. A theme slowly took shape: here was a young man labeled as unprincipled, yet almost every conversation was about principles. Even when Jozeph had been the king of party-life in Croatia, he'd lived by Godfather-like standards of justice. However, they were so unspoken, he wasn't aware of them himself. As I called attention to his heretofore unseen moral code, Jozeph began to notice his deeply felt sense of the ethics of everyday life. An unspoken self emerged: a sharp-eyed, 21-st century realist, who could empathize with and stand up for those who were totally different from him.

Jozeph eventually met an absolutely wonderful woman. They fell in love and set up house together. What drew her to him? A lot, but most dramatic was her telling Jozeph, "You're the most principled person I've ever known."

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