The power of custom in psychotherapy

It’s the kind of telephone call that every therapist gets and every therapist hates to get.

“I’m sorry to disappoint you on such short notice, but I can’t come in today.”

It was a patient who had come only once before, the week prior, and though he was articulate about what troubled him, one could discern that he was deeply conflicted about whether he even wanted help at all to solve his problems or even ease his difficulties. So it was no surprise to me when he attempted to cancel.

But here he was, live on the phone, the morning of his appointment, his words saying one thing, I’m not coming—but his voice full of conflict and ambivalence. One could sense the pulse of life in him, fragile and quivering.

Patients cancel with painfully short notice or sometimes with no notice at all. That is the way of the world. It’s a loss for them, for you, a loss of money and time. Most often there is little to be done. You put the receiver down and regrettably, you write them off. People will be people, you tell yourself. But every once in a while, you get a feeling that someone who ordinarily might cancel, ought to be encouraged, encouraged that is to keep the appointment. Was this one of those people, I wondered.

“Is there anything keeping you from making your appointment today?” I asked.

“Well, it’s just that as I explained last week, I wasn’t sure if I wanted to come at all…”

“Yes, you are in conflict, that’s true. But you know it is customary, usual and customary that is, to keep appointments unless they were cancelled with 24 hours notice. You’re aware of that custom, aren’t you?”

“Hmm…it’s a custom? I suppose it is,” he said haltingly, sparingly. Okay, I will keep the appointment.” And so it was.

What is it about customs that seem to excite less resistance while “laws” and commandments appear to excite more resistance?

From my own experience it would seem that “customs” act in some sense seem to lubricate the traumatized psyche to negotiate the torturous demands of id and superego while “laws” further tighten an already overloaded, cramped psyche.

by

How to choose a therapist

It’s easy to find a counsellor but perhaps more difficult to know if you’ve found one who is right for you. There are a number of questions you can ask that will help you to choose a counsellor. This short article outlines 13 of these questions, in no particular order (please note, the words “therapist” and “counsellor” are used interchangeably).

1. What does it feel like for you to sit with the therapist?
Do you feel safe and comfortable? Is it easy to make small talk? Is the person down-to-earth and easy to relate to or does he or she feel cold and emotionally removed? Is the counsellor “stuck in her head,” or overly emotional and empathic? Is the therapist a “know-it-all” or arrogant? Sure, for many of us, going to a therapist for the first time is a bit anxiety provoking, and it’s important to tease out our own “stuff” from the actual counsellor. But, if a counsellor doesn’t feel like a good fit for you, that’s okay; there’s absolutely no contract or rule requiring you to continue working with any counsellor. However, it’s important to check to see if there’s a part of you avoiding therapy through a dislike or judgment of the therapist. If you find yourself reacting negatively to every counsellor you see, then the issue could be yours and may warrant your sticking it out with a counsellor in an effort to work through your fears of beginning therapy.

2. What’s the counsellor’s general philosophy and approach to helping?
Does your counsellor approach human beings in a compassionate and optimistic way? Does he or she believe humans are born loving and lovable, or does the counsellor believe people are genetically deficient? We at GoodTherapy.org believe that good therapists and counsellors adhere to the elements of good therapy.

3. Can the counsellor clearly define how he or she can help you to solve whatever issue or concern has brought you to therapy?
Experienced counsellors explain how they can help, are able to give you a basic “road map,” to their approach, and can even give an indication of how you will know when therapy is finished.

4. Does the counsellor seek regular peer consultation?
An important professional activity for any wise counsellor is regular consultation with peers or consultants. Consultation serves a number of purposes, such as, but not limited to, reviewing cases, receiving advice, getting unstuck, discovering one’s own blind spots, and noticing how one’s own “stuff” may be getting in the way. Consultation provides a counsellor with a necessary reality check, a degree of objectivity, and feedback. Even the best therapists benefit from the help of others.

5. Can your counsellor accept feedback and admit mistakes?
A healthy counsellor is open to feedback and to learning that something he or she said hurt or offended you. Good therapists are willing to look at themselves, to check their feelings, and to honestly and openly admit mistakes.

6. Does the counsellor encourage dependence or independence?
Good therapy doesn’t solve your problems; it helps you to solve your own. Likewise, good therapy doesn’t soothe your overwhelming feelings; it helps you learn to soothe your own feelings. Like the old proverb, therapy is most powerful when it helps people to learn to fish for themselves rather than rely on another to feed them. If your counsellor provides wisdom, answers, or emotional support without encouraging you to access your own resources, it is more likely you will become dependent on your therapist to help you feel better, rather than learning to depend on yourself.

7. Has your counsellor done his or her own therapy?
One of the best ways to learn how to help someone to heal is to do your own therapy and to experience the healing process first hand. Thus, therapists who have been in their own therapy benefit from this as a learning experience and are probably better equipped to help because of it. Most good healers are wounded healers—those who, in the process of healing their own wounds, have developed the know-how to help others to heal theirs.

8. Does the therapist have experience helping others with the particular issues for which you are seeking therapy?
The more experience therapists have addressing a particular issue, concern, or problem area, the more expertise they have developed.

9. Does the counsellor make guarantees or promises?
It’s important for a therapist to provide hope but not absolute unconditional guarantees. If you have the will to change and put in the necessary time and energy, healing is possible. Most of our wounds and defences are the result of what has happened to us and to those around us. Healing can happen quickly in psychotherapy, but only after getting safely through the layers of protective gate keepers, which understandably can take a long time. So, although everyone is capable of healing, changes can take years to happen for some people; unfortunately, because time is limited, some may never achieve the level of healing they desire in this lifetime. In addition, people are not always at a time and place in their growth where they are ready to heal, and a given therapist may not be the right person to help them. Overall, there are numerous factors at play in the therapy process that may contribute to or interfere with healing; we are conscious of some of these factors and unaware of others. And so, there are no guarantees without conditions.

10. Does your counsellor adhere to ethical principles in regard to issues such as boundaries, dual relationships, and confidentiality?
There are numerous ethical guidelines designed to keep counsellors from harming clients. Most importantly, there is a guideline barring against dual relationships. When a therapist enters into a therapeutic relationship with a client, he or she should not have any other relationship with that person, such as teacher, friend, employer, or family member, although there are some exceptions to this rule in villages or very rural communities. The principle behind this guideline is really about whose needs are being met. A therapist should be there to meet your counselling-related needs for empathy, understanding, support, guidance, unburdening, and healing. When a counsellor gets his or her own needs (emotional or otherwise) met by the client, he or she has crossed a boundary, and the therapy process can be damaged or ruined. This is one of many ethical guidelines, and it’s important for a counsellor to adhere to these.

11. Is the counsellor licensed?
Licensure implies that a counsellor has engaged in extensive postgraduate counselling experience which, depending on the state of licensure, may include up to 3,000 hours of required supervised experience. It also means the counsellor has passed a licensing exam. There are many unlicensed therapists who have years of experience and do excellent work, but licensed counsellors have (generally but not always) jumped through more hoops and have undergone more extensive supervision than unlicensed counsellors. You can contact your state professional licensing board to verify the licensure of a provider.

12. Does the counsellor have a graduate degree?
There are numerous people who call themselves “counsellors” or “therapists” because they have taken a weekend seminar or have learned a certain therapeutic approach. But without a graduate degree in counselling, psychology, social work, marriage and family therapy, or another related field of study, such a person lacks the education, training, and skills to provide safe psychotherapy and counseling. It is highly recommended to only work with counselors and therapists who have graduate training. People without graduate-level education in a mental health field may lack the necessary skills and know-how to properly diagnose and treat issues, and there is a great danger in misdiagnosing and mistreating. Psychology is an enormous field, and human beings are multifaceted and complex. It takes years of education and training to effectively help people. Without the proper training, there is great risk of causing harm.

13. Does the counsellor have postgraduate training?
Many new counsellors fresh out of graduate school have had excellent book learning but lack enough actual counselling experience to claim expertise and feel totally confident. Postgraduate training in a particular approach to psychotherapy is often the next step in a new counsellor’s career and is helpful in getting a new counsellor to the next level, where he or she will have more confidence and know-how.

by