“My granddaughter wants to spend Christmas with her other grandma.” Doris looked out the window while slowly chewing on a piece of gum. “She’d rather be with Fun Grandma,” she huffed as though trying to imitate laughter.
“And these are supposed to be the golden years,” she continued. I felt the need to change the direction of the session and asked if she had researched local meet-up groups, something we had discussed the week before. “I had trouble getting on the internet,” she said.
Doris, I believed, needed to take action if she was going to feel better, and I believed it was my mission to motivate her to take that first step.
“It’s just that I know you’re happiest when you’re with people,” I said, “and I think one of these groups could be part of the answer.”
“I don’t think I’m very approachable anyway.”
“Why do you say that?”
“I have an uninviting face.”
“I don’t think there’s anything uninviting about your face.”
“You’re very kind.”
“I’m serious. Has anyone ever told you that?”
“They don’t have to say it. I can tell.”
That intervention, like the others I had tried, proved to be ineffective, although I kept at it for the remainder of the session. Imagine Winnie the Pooh trying to cheer up Eeyore, Pooh making one reasonable point after another while Eeyore just keeps making excuses, the conversation finally ending when Eeyore realizes he has again lost his tail.
Later that week I discussed the session with Ari, my clinical supervisor. “I’m trying so hard,” I told him, “And I feel like she’s not doing her part. She’ll ask me what she should do to feel better, but when I offer an idea, she always has an excuse.”
Ari inhaled deeply as though attempting to fully absorb what I had said. “Sometimes,” he finally said, “our clients tell us they want one thing, but deep inside they’re pulling for us to do something else. When she made that comment about her face being uninviting, I think she was trying to tell you something important about herself.”
“I get that she’s unhappy.”
“There’s a depth to her pain. I wonder if she needs you to really understand that.”
“I think I do understand that.”
“You understand her suffering on a cognitive level, but I wonder if she needs more. I wonder if she needs you to understand it on a deeper, visceral level. What’s often most helpful to our patients is the experience of being truly understood.”
The truth of his words stung. I thought back to my own times of distress and how others had often told me to cheer up and look on the bright side. Rather than cheering me up, those exhortations usually made me feel like a burden. They made me feel that my distress was intolerable and that, as long as it remained, I too would be intolerable.
I now saw that, by being the Pooh Bear to Doris’ Eeyore, I had inadvertently given her the exact same message. “She must feel so alone,” I said to Ari. “She tells me that her children are always telling her to stop being so negative. And now I’m doing the same thing.” When I next saw Doris, I asked more questions and tried to more fully understand her. When she again complained that her granddaughter didn’t want to spend Christmas with her, instead of inquiring into what exactly the girl had said, I said, “Help me to understand what that feels like, being rejected like that.” As soon as those words left my mouth, I feared that I had set something dangerous into motion, as though I had given Doris permission to step into a black hole from which she would not be able to escape.
But she did not step into a black hole. What she did instead was describe what it felt like to be a nuisance to her granddaughter, and she then shared how she had felt like a nuisance to people most of her life. She continued to open up and share more associations. While our previous sessions had started to feel like repetitions, I was now learning new things about her.
Our sessions over the next several months were too complicated for me to summarize here, but I will say that exploring her most painful emotions proved essential to the gains we made. I would later discover that Doris had developed an attachment to certain aspects of her pain that would require additional interventions. However, before these interventions had any chance of succeeding, Doris first needed to feel understood.
Questions for Thought and Discussion
How do you resonate with the author in recounting the work with Doris?
Can you think of one of your clients who struggles in similar ways to Doris?
How might you have intervened differently with Doris?
File under: The Art of Psychotherapy, Musings and Reflections
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Armed with good intentions and extensive training in cognitive-behavioral therapy, I had been a therapist for just a few months. Doris told me during our first session that she hadn’t been truly happy since her divorce 20 years earlier, and she had spent every subsequent session describing how unimportant she felt to her children and grandchildren.“And these are supposed to be the golden years,” she continued. I felt the need to change the direction of the session and asked if she had researched local meet-up groups, something we had discussed the week before. “I had trouble getting on the internet,” she said.
Doris, I believed, needed to take action if she was going to feel better, and I believed it was my mission to motivate her to take that first step.
“It’s just that I know you’re happiest when you’re with people,” I said, “and I think one of these groups could be part of the answer.”
“I don’t think I’m very approachable anyway.”
“Why do you say that?”
“I have an uninviting face.”
“I don’t think there’s anything uninviting about your face.”
“You’re very kind.”
“I’m serious. Has anyone ever told you that?”
“They don’t have to say it. I can tell.”
Moving Beyond ‘How Do You Feel’ in Therapy
I proceeded to initiate a detailed discussion about her face. I badly wanted to lead her out of her misery and to help her to evaluate her thoughts (helping her to recognize that her face was really not so uninviting and that others were probably not judging her as harshly as she imagined) seemed like the best path to take.That intervention, like the others I had tried, proved to be ineffective, although I kept at it for the remainder of the session. Imagine Winnie the Pooh trying to cheer up Eeyore, Pooh making one reasonable point after another while Eeyore just keeps making excuses, the conversation finally ending when Eeyore realizes he has again lost his tail.
Later that week I discussed the session with Ari, my clinical supervisor. “I’m trying so hard,” I told him, “And I feel like she’s not doing her part. She’ll ask me what she should do to feel better, but when I offer an idea, she always has an excuse.”
Ari inhaled deeply as though attempting to fully absorb what I had said. “Sometimes,” he finally said, “our clients tell us they want one thing, but deep inside they’re pulling for us to do something else. When she made that comment about her face being uninviting, I think she was trying to tell you something important about herself.”
“I get that she’s unhappy.”
“There’s a depth to her pain. I wonder if she needs you to really understand that.”
“I think I do understand that.”
“You understand her suffering on a cognitive level, but I wonder if she needs more. I wonder if she needs you to understand it on a deeper, visceral level. What’s often most helpful to our patients is the experience of being truly understood.”
The truth of his words stung. I thought back to my own times of distress and how others had often told me to cheer up and look on the bright side. Rather than cheering me up, those exhortations usually made me feel like a burden. They made me feel that my distress was intolerable and that, as long as it remained, I too would be intolerable.
I now saw that, by being the Pooh Bear to Doris’ Eeyore, I had inadvertently given her the exact same message. “She must feel so alone,” I said to Ari. “She tells me that her children are always telling her to stop being so negative. And now I’m doing the same thing.” When I next saw Doris, I asked more questions and tried to more fully understand her. When she again complained that her granddaughter didn’t want to spend Christmas with her, instead of inquiring into what exactly the girl had said, I said, “Help me to understand what that feels like, being rejected like that.” As soon as those words left my mouth, I feared that I had set something dangerous into motion, as though I had given Doris permission to step into a black hole from which she would not be able to escape.
But she did not step into a black hole. What she did instead was describe what it felt like to be a nuisance to her granddaughter, and she then shared how she had felt like a nuisance to people most of her life. She continued to open up and share more associations. While our previous sessions had started to feel like repetitions, I was now learning new things about her.
Our sessions over the next several months were too complicated for me to summarize here, but I will say that exploring her most painful emotions proved essential to the gains we made. I would later discover that Doris had developed an attachment to certain aspects of her pain that would require additional interventions. However, before these interventions had any chance of succeeding, Doris first needed to feel understood.
Questions for Thought and Discussion
How do you resonate with the author in recounting the work with Doris?
Can you think of one of your clients who struggles in similar ways to Doris?
How might you have intervened differently with Doris?
File under: The Art of Psychotherapy, Musings and Reflections