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Wisdom In Psychotherapy - Page 2

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What Is Wisdom?

Virtually every culture has a word for wisdom, and people worldwide have little difficulty identifying those they think of as wise. But when it comes to precise definitions, wisdom is quite difficult for most people to describe. In this regard, it’s similar to a rather different area of human interest: hard-core pornography. In 1964, Supreme Court Justice Potter Stewart observed that hard-core pornography “is hard to define, [but] I know it when I see it.”

The study of wisdom is further complicated by the fact that there appears to be an inverse relationship between thinking of oneself as wise and actually being wise. Indeed, when I conducted an informal poll asking experienced clinicians to describe a wise therapist, one of the most commonly mentioned attributes was awareness of the limitations of one’s own understanding. This surprisingly ancient insight (found everywhere from Egyptian papyri to the teachings of Confucius) suggests that anyone who thinks that he or she is wise probably isn’t. The notion is supported by modern research demonstrating that, in general, people who think they’re competent are usually less competent than those who think they aren’t—the so-called Dunning-Kruger effect.

While wisdom has been investigated by reviewing ancient texts from contemplative traditions and setting up laboratory experiments to see how people tackle complex, ambiguous life situations, one of the most fruitful approaches has been to look at implicit theories—our often unarticulated ideas about what makes a person wise. That was the inspiration behind the aforementioned little study I conducted, in which I asked 30 seasoned clinicians to answer four questions: (1) What does it mean to be wise? (2) What are the particular qualities of a wise psychotherapist? (3) What gets in your way when it comes to being a wise therapist? and (4) Do you consider the cultivation of wisdom to be a treatment goal for your clients?

I discovered that when clinicians asked themselves these questions, their answers accorded pretty well with what researchers have found more broadly. Just grappling with the question seems to help us to become a little wiser, enriching our therapeutic work. But it can create conflicts for us in our practices, because, as we’ll see, wisdom can get in the way of following empirically supported protocols.

Here are some of the characteristics of wisdom identified by both researchers and the therapists who participated in my survey:

Concern for Others. Therapists in the survey overwhelmingly cited genuine compassion—concern for the suffering of others and a desire to help—as an important quality of a wise psychotherapist. This involves putting our client’s needs above our own, moment to moment.

It begins by actually showing up for the session, which is no easy task. Sometimes we’re concerned about looking kind or capable, so we posture to boost our image instead of being honest: “I tried reaching your doctor, but wasn’t able to get in touch,” rather than admitting, “I’m sorry, I forgot to place the call.” Or we fail to really pay attention because we’re distracted by outside worries or can’t be with pain that hits too close to home. I’ve often found myself tuning out while listening to a story about metastatic cancer or a kid’s car accident because I couldn’t bear to think that it might happen to my own wife or child.

A psychiatrist friend and colleague nicely summed up the difficulty of being fully present in her work. When asked what got in the way of her being a wise psychotherapist, she replied, simply, “Me.” Indeed, most therapists in my survey said that acting out of personal fears, concerns, and desires regularly prevented them from acting wisely.

But the opposite—wise presence—is possible. As Jon Kabat-Zinn said about speaking with the Dalai Lama, “You know, when talking with him, it feels like he’s really there with you, with genuine interest in the moment—not scanning the room for a better networking opportunity.”

In academic studies of wisdom, concern for others is often summarized as “concern for the consequences of our actions, in the near and long term, for those close and far.” By contrast, as we think of our own or others’ foolishness, it almost always involves focusing on immediate gratification for me or mine. President Clinton wasn’t thinking about others, or considering the long-term consequences of his actions, when dallying in the Oval Office with “that woman.” Nor am I thinking of the big picture when, dreading the paperwork, I’m tempted to take on a self-pay client over one with managed care coverage.

How might a clinical day be different if we stayed focused on the likely consequences of our actions, near and far? Would we treat our difficult clients differently, or perhaps worry less about looking good in front of our colleagues? Might we be less concerned about hanging onto our more gratifying, entertaining, or high-status cases?

In Buddhist traditions, wisdom and concern for others (compassion) are inseparable—they’re described as two wings of a bird or two wheels of a cart. They represent the coming together of the head and the heart, an integration which, itself, is often cited as a feature of wisdom. As therapists, developing either wisdom or compassion, one without the other, can lead to trouble. If we feel compassionately toward a client, but have little wisdom, we’re liable to become flooded with emotion, unable to see a path forward, and conclude that the treatment is hopeless. By contrast, if we’re wise—we grasp the big picture of a client’s situation—but are out of touch with his or her emotional pain, our comments will likely fall on deaf ears. Our clients need both wisdom and compassion. As psychiatrist Daniel Siegel puts it, they need to “feel felt,” and they need us to help them find a path through their suffering toward a fulfilling life.

Concern for others can change how we treat clients who are overly focused on their immediate desires. Getting clients to see the consequences of behavior for themselves and others—and choose ethical action—could become clinical goals. We might point out that the affair they’re considering is likely to feel good now, but will eventually cause a lot of suffering. If you live in Cambridge, Boulder, or Berkeley, you might even address the environmental consequences of buying an SUV. We often fear that exploring consequences in this way might come across as moralistic or parental, interfering with the safety of the therapy relationship. But sometimes addressing the short- and long-term consequences of actions, for those near and far, can enhance everybody’s well-being—even if managed care reviewers might prefer we choose a narrower focus.

Reflective Attitude. While most of us value lively spontaneity in a therapist, impulsivity can be a real problem. Virtually all my therapeutic and supervisory blunders occurred because I acted first and thought second. Early in my career, a woman revealed to me that she was mortified to have had a sexual fantasy about Jesus while looking at a statue of him in church. It so happened that a gay supervisee had recently told me he’d had the same experience as an adolescent, and it was what first made him suspect he was gay. Excited by my new insight into these forbidden matters and wanting to relieve my client of her shame by normalizing her experience, I shared this information with her. She canceled the next appointment. When I called to ask why, she told me that she couldn’t work with a therapist who was so obviously perverted. As one of my early psychodynamic supervisors once put it, “The right interpretation at the wrong time is the wrong interpretation.”

I’ve had many other unreflective moments in treatment, including “self-disclosing” just because I really wanted to tell my story, unthinkingly making a joke my client found offensive, suggesting a client confront a fear he wasn’t ready to acknowledge, and discussing violent fantasies as though they were normal when my client thought they were evil. Then there have been the inner unreflective moments, when I’ve become attached to facile, reductionist understandings of my clients’ difficulties: “It’s all a reaction to childhood sexual abuse”; “It’s because of his narcissistic father”; “She’s a borderline.” Across wisdom traditions and implicit theories of wisdom, the capacity to activate our frontal lobes, think before acting, reflect on our particular viewpoint, and consider the viewpoints of others appears repeatedly.

I recently learned an acronym from a friend that I find helpful: W.A.I.T. It stands for Why Am I Talking? This simple question can help cultivate a reflective attitude in treatment, assisting us in being a little wiser as therapists. As I sit with a client who’s getting enraged at his wife and feel the urge to calm him down, I can reflect on whether this is really in his interest, or is just to quiet my own fear. As I sit with an attractive client talking about her insensitive husband, I can pause and notice that I’m enjoying being seen as the more sensitive, lovable man. W.A.I.T.-ing helps.

it’s likely to contribute to the project at hand. Unfortunately, in our enthusiasm to learn techniques or protocols instead of developing the instrument of the therapist, it’s easy to forget to reflect.

Insight. The therapists I surveyed repeatedly mentioned that insight into our own inner experience and that of others—emotional intelligence—is an important element of wisdom. This involves: (1) Listening deeply, (2) Appreciating the factors that make us all experience the world differently, and (3) Being aware of the wounds and conditioning that inform our reactions to others. Insight helps us see that a “tired” client is actually depressed, or a confused client is having difficulty acknowledging anger toward her daughter. It also helps us understand why we’re reluctant to call a client we’ve neglected or are overly eager to please an intimidating one.

Here our earlier therapy traditions have much to offer. Therapists have long recognized the importance of listening deeply, whether inspired by Carl Rogers’s use of “reflective listening,” Sigmund Freud’s “evenly hovering attention,” or Theodor Reik’s “listening with the third ear.” Our bio-psycho-social models also help us step out of our own perspectives to appreciate how radically different the world can be for someone with another familial, cultural, or biological history. While the wise sages of old may have had an intuitive understanding of these matters, they didn’t have the maps and data that we have today.

We also have another tradition that has the potential to boost wisdom—the supervisory relationship. We can use supervision to explore our blind spots and discover where our wounds and conditioning get in the way of seeing clearly. During my internship, I recall meeting with a young woman who was deeply depressed. Week after week, she pointed out that my interventions were useless and her life was irretrievably hopeless. I used to leave sessions thinking, “I was a good student. I could’ve gone into so many fields. This is clearly not my calling.” Occasionally, following a particularly discouraging session, she’d come in the next week looking a little brighter. Once she offered, “Last week was a little helpful.” I thought, “To you, maybe. It just made me depressed!” Luckily, my supervisor helped me step back from my preoccupation with my own incompetence to notice that when this client felt that I really got it—that I could feel some of her despair—she felt more understood and a little less alone. This helped lift her depression.

This sort of insight, so central to the therapeutic wisdom of old, may not be particularly relevant to modern, symptom-focused treatments. In fact, a clinician monitoring progress with a depression inventory might view weeks of shared despair as indication that therapy was going in the wrong direction. But for therapy aimed at awakening or finding meaning in life, insight is essential. Using supervision to this end probably requires both our intention to grow wiser and wisdom in our supervisor—since it’s equally possible to use supervision just to gain approval for what we’re doing, collude in developing a simplistic view of our client’s difficulties, or otherwise reinforce therapeutic foolishness.

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3 comments

  • Comment Link Friday, 12 April 2013 16:31 posted by elsie st-aude

    Wisdom is totally different from compassion. Like the therapist in the article, everyone who shows concerns about others or for the suffering of someone' else prove he is capable of compassion which is an ethical professional action for those who have called to be a good caregiver. Wisdom is rather a way of thinking. You are wise when you can see beyond the appearence of life. you are wise when you can see and think differently from the world around you. wisdom is a gift given from God. you can have wisdom when you look for a better understanding of his word and obey to it. One of the best way to get started is first by having the fear of his name.

  • Comment Link Wednesday, 27 March 2013 12:44 posted by Eugene Usner

    Wonderful explanation on Wisdom and Psychotherapy---Can We Afford It? My response, we cannot not afford it. I have been a therapist for 40 years with the opportunity to attend workshops and training with the above mentioned masters. When I supervise social work interns, they have barely heard of these masters. The importance of the therapeutic relationship has been minimized in lieu of "evidenced based therapies". As the old saying goes "just follow the money". As another saying goes" you get only what you paid for". Thanks for a most enlightening and well written article about the value of wisdom and psychotherapyt. I do hope someday society and our culture will value psychotherapy without stigma. Valueing both the wisdom of the therapist and evidence based research should be the goal.