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When Therapy Is Going Nowhere - Page 6

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Stop pushing for change, and wait for another opening when life teaches lessons. Cindy and I moved on to work on ways she could keep as healthy an emotional balance as possible in a relationship I thought was basically unhealthy. At some point, one of us would be proven right by the outcome of the episode. The result was that most of my frustration melted away because I didn’t define my goal as getting her out of this relationship. Rather, I tried to help her learn what she could from the situation she’d chosen to be in.

Not having to defend her decision allowed Cindy to appraise the relationship realistically as it developed. She eventually came to focus on the fact that the man wouldn’t let her see his apartment. With my support, she dug in her heels on this one. I coached her on how to talk with her boyfriend about her feelings and how not to back down when he claimed his place was so shoddy that he didn’t want to disrespect her by taking her there. Finally, she decided to tell him that she wanted her loan repaid and that she wasn’t going to give him any more money, whereupon he disappeared from her life.

When we processed all of this, she saw clearly how she’d blinded herself to red flags that had come up in the relationship. Recently, about 15 years after we’d finished therapy, I got an email from her saying that her life was good, that she’d had better relationships with men in recent years, and that none of them had borrowed money from her.

Becoming a Therapeutic Craftsperson

If the risk for new therapists is falling on their faces because they’re still learning their craft, the risk for experienced therapists is being captured by our competence. We become habituated to the role of “pretty good therapist,” and we stop getting better. The research behind this idea is sobering: clinical outcomes aren’t related to the therapist’s experience level. Overall, experienced therapists have no better success than newbies. However, unless we can compare our work with fellow therapists on similar cases and find that others have succeeded where we’ve failed, we’re tempted to assume that when therapy falls short, the fault is with the clients. We might tell ourselves that they just aren’t motivated, that they have an Axis-II diagnosis, or that their marriage was doomed anyway. Often our colleagues help foster our inflated sense of capacity, rushing to reassure us that our clinical failures are either not failures or not our fault, because we’re competent therapists.

How do we avoid being captured by our competence? I’ve learned that the key is never to stop being a student. It’s hard to habituate while being a graduate student because there’s always something new coming at you; there’s always someone who knows more than you and is paid to teach it to you. The challenge after leaving school is to learn how to keep learning. Anthropologist and cyberneticist Gregory Bateson’s research showed that dolphins figured out how to create novel jumps and flips when they realized they’d only be rewarded for originality, not for doing their old tricks. Bateson called this “second-order learning”—learning how to learn. Therapists, too, need to bring this type of learning into practice.

The therapists I’ve admired most in my career have been those who continually change and develop while holding onto the core of who they are as therapists. They’re interested in new models and new evidence, but not in serially reinventing themselves with each new fad. What I’ve come to see recently is that learning new models counts for little if therapists don’t continually improve their basic craft, the day-to-day skills of their work. Not focusing on the basic craft is like being a surgeon who learns advanced techniques without being good at making incisions and preventing infections.

Another strategy for avoiding decades on a clinical plateau is to be a perfectionist without being immersed in self-criticism. I always question whether I could have done better with a difficult case, but I rarely beat myself up over it. I experiment with the small details of therapy (like how to frame key questions) and with the structure and flow of therapy (like how to open sessions and to blend individual and couples conversations). I’m a sponge for nuance and details when I see master therapists share their work. However, I pay more attention to what they do—their craft—than to how they theorize it.

I get a rush when I pick up a gem from a colleague who has a skilled turn of phrase or way of structuring an intervention. For example, a colleague recently recounted a small intervention he’d made with a stuck case: he’d invited the client to begin sitting in a chair different from the one she’d used for years in the therapy room. The client’s energy in the session shifted noticeably, and my colleague capitalized on the new energy to move the work forward again. Talk about breaking the power of habituation!

These days, I’m having the most fun of my career trying to hone my craft in “discernment counseling,” a specialized way to work with mixed-agenda couples in which one partner is leaning out of the relationship and the other one wants to save it. What I enjoy the most is making adjustments in the protocol because a new wrinkle has shown itself.

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