1. Showing up late for the appointment: Yes, I know this is supposed to be a big no-no. And The Shrink is exceedingly guilty of this. He is almost always late from 5 minutes an hour. But, quite frankly, this doesn't bother me at all. I have plenty of stuff to do while I wait. I don't feel like he forgot me or doesn't value my time. But people run over or things take longer trying to leave the house than anticipated, or things come up that have to be handled. Perhaps there is something wrong with me, because this just doesn't faze me at all. It bothers The Shrink to no end and we have had many conversations about it, but I just don't care. Verdict: Not Guilty By Reason of Effect
2. Eating in front of the client: I can see where this could be a no-no. It's rude to eat in front of someone when they aren't eating as well. And it shows poor time-management skills, a lack of discipline, or a health issue when either party feels like they need to eat during session. The Shrink does this consistently, eat in front of me. But he almost always offers to share, occasionally even insisting. And he has only started doing it since things have become much more casual between us. Once again, him eating in front of me doesn't bother me at all. I guess could be construed as distracting sometimes but for the most part I take it as a sign that he feels comfortable enough around me to grab a snack if he's hungry. (It's not like he schedules time between patients that he can eat then instead.) Verdict: Guilty, misdemeanor level.
3. Yawning or sleeping during session: This is one that I would take very personally if it happened. There are times when The Shrink is obviously exhausted, although more often than not he will deny it. And there are times, on rare occasions, when he has been known to yawn once or twice during session, usually when he is obviously exhausted. But he has never fallen asleep or come anywhere close to falling asleep. And he has never yawned to the point of being intrusive or offensive. Verdict: Innocent.
4. Inappropriate disclosures: This is quicksand territory for me. I am an emotional voyeur. I want to know everything about everyone and eat up as much personal information as I can get about everyone. Even though it's not appropriate, I have no limit as to the amount of personal information that I wish I knew about The Shrink. So, from my boundaries, he has never made an inappropriate disclosure. Now, from more traditional boundaries, this becomes more debatable. A lot of his disclosures are made deliberately to illustrate a point. All of the big ones have been extremely intentional. There are 2-3 things he has told me that are quite personal and quite intense but that he told me because they related directly to an issue I was having at that moment. They were all things from his past that have been resolved as well so it's not like he was role-reversing the therapy process. On the other hand, there are a million little things that he has disclosed that have nothing, or very little, to do with the problems at hand. And we will often get off onto tangents about these things and end up having conversations instead of therapy. And, truth be told, there has been at least one issue that we have had to come back to almost every session that is completely his issue and not mine - that is his habitual lateness. Again, like the other things, his disclosures don't bother me. In fact, I love them and encourage them. Occasionally, I have solicited them although I try not to do this often because I respect his need for personal boundaries. Verdict: Not Guilty by Reason of Entrapment.
5. Being impossible to reach by phone or email: The Shrink always returns emergency phone calls. He has made a point of making sure I know that if I am in crisis and don't know what else to do, he is available by phone for short "coaching" sessions. I am to call and leave a message and he will return it. And he has always returned my call before bed the same day in those cases. If I call for any other reason, I typically hear back from his admin assistant within a few days. Other than those coaching sessions, The Shrink is not available for anything else between sessions. BFF's shrink checks her blog before their sessions because that's where she does her Homework. I can email the Med-Shrink links to articles on relevant topics between appointments and he will return my email with instructions or to tell me we will talk about it at my next appointment. I know many people whose shrinks read their blogs anywhere from regularly to occasionally. The Shrink does not do that period the end. So, bottom line, The Shrink isn't as available to me as I wish he was, but he is not impossible to reach in an emergency. Verdict: Not Guilty (which is not exactly the same as Innocent).
6. Distracted by a phone, cell phone, computer or pet: Never. If his cell phone happens to go off in session and he has forgotten to set it to vibrate mode, he will pull it out of his pocket and silence it then put it back. He has never, in 3 years, taken a call during an appointment. One time we both got distracted looking something up on the computer but a) I started it, b) it was directly related to me, and c) it was both mutual and consensual. Verdict: Innocent.
7. Expressing racial, sexual, musical, lifestyle and religious preferences: Even the article makes a point of saying this in an extension of the disclosure rule. And, for the most part, the same thing applies to this as to that: for myself, I soak it up enthusiastically. He never brings these things up on his own, rather they get expressed as part of the conversation/discussion. When his views on things do come up they are never presented as judgments and he has never even implied that he expects others to share those preferences. I not only don't want to know about his preferences, I am interested in what he thinks and believes and enjoys. As for being distracting or detrimental to the therapy process, maybe. There have been things I have not really wanted to bring up because I know his views on them are not positive. But for the most part, that is a matter of trusting him as a therapist to keep his preferences for himself separate from his role as a therapist. And he does this very well. Verdict: Not Guilty by Reason of Entrapment
8. Bringing your pet to the psychotherapy session: He has never done this. Given the setting, this is not likely something he's even considered doing. Verdict: Innocent
9. Hugging and physical contact: The Shrink does not do this, period. He has extremely well-defined physical boundaries. I think he might have shaken my hand the first time we met but I'm not positive about that. He sits across the room from me, regardless of which chair I choose to sit in. When he hands me something, he stretches his arm as far out away from him as possible so as to maintain maximum physical distance between us. He doesn't do this in an "avoid-me-like-I-am-the-plague" kind of distance but rather in an "I'm-not-going-to-hurt-you-or-spook-you-by-getting-too-close" kind of way. And, based on the kind of guy he seems to be, I can't imagine him ever interacting sexually with a patient. It would go against so much of who he is - totally not his style. Verdict: Innocent.
10. Inappropriate displays of wealth or dress: This one is actually funny. He doesn't have means to display inappropriate amounts of wealth. And even if he was sitting very comfortably financially, he's not a flashy kind of person so I still doubt he would even be tempted to do this. As for jeans and such, yes he does wear jeans quite a bit but generally with a nice shirt and tie. Given the environment where he works, he dresses very appropriately. And I am far more comfortable when he is dressed down than when he is dressed up. (I can always tell the rare days when he has to make a court appearance because he is dressed to the nines and looks distinctly uncomfortable.) Distracting clothing/accessories is not a habit/problem of his. Verdict: Innocent.
11. Clock-watching: Quite the opposite. He never looks at the clock, never keeps track of time. I, however, am a clock-watcher. I am practically paranoid about boundaries and not breeching them (mostly because I want to so badly). So I watch the time to make sure I don't run over our time. A couple of times I have deliberately made it seem as if I wasn't paying attention to the time to see how he would respond and he didn't do anything until we had gone over by 10 minutes. Even then he didn't look at the clock until I did, after he mentioned that we needed to wrap up. Verdict: Innocent.
12. Excessive note taking: The Shrink takes notes, yes. The Shrink has a memory for details that has more holes than Swiss cheese so if he doesn't take notes, he has no chance of remembering in session what happened last session. But he isn't distracting about it. He doesn't look like he's paying more attention to his notes than to me. About a third of the things he writes down, he speaks aloud what he is writing down by way of emphasizing that I've said something important. Could he be more transparent in his note-taking? Quite possibly, yes. Is his way of incorporating his note-taking into the process effective and appropriate? Yes, most certainly. Verdict: Innocent.
Here's the tally:
Innocent: 7/12 (58%)
Not Guilty: 4/12 (33%)
Guilty: 1/12 (8%)
So obviously, he's no heinous, repeat offender with a warning flag of bad behaviors. Still, I was struck by how many of these behaviors he does albeit not to a pathological level. He's late all the time. He eats during session. He discloses a lot. He discloses personal opinions. And he's not incredibly accessible between appointments. BUT... he would never even consider being unethical about his boundaries, he dresses appropriately, he pays attention to me (not other distractions or the clock or even his own notes) and he never falls asleep to any degree.
I guess, more than anything, the list of habits made me stop and take stock of the quiet rumblings of discontent I have been experiencing. It gave me a jumping off point for determining what my problem is. It let me confront my heretofore abruptly silenced thoughts of "Is he the right shrink for me?" in a way that my mind and conscience would allow. Here is what I actually found out...
The Shrink is a good psychologist and a good therapist. He is human and he has his quirks and, in my book, this is important to me. It's not just acceptable or tolerable, it's a requirement. I cannot and will not open up to someone who is fake with me. And the more "real" The Shrink becomes to me, the more I trust both him as a person and his advice as a professional. I know that this is not the "norm" for people in therapy, but it is very much me.
What is actually getting to me is the style of therapy itself. I see BFF with her structured, preplanned sessions and I compare it to the relaxed, go-with-the-flow style of my therapy. I envy the amount of work her therapist does for her. She keeps her on track, assigns homework and follows up on it, pushes her into looking at things she might not want to look at in the moment. She even keeps up with BFF's blog outside of session time. And her sessions are typically an hour and a half long. (This last one is because she is going through a woman's trauma clinic whereas I am stuck in the insurance loop.)
But then, I realized that the statement I made above is more true than the casual interpretation of it:
I envy the amount of work her therapist does for her.
The key point, and I didn't even realize it, is for her. Her shrink keeps the agenda. Her shrink keeps her on task. Her shrink is the accountable party for the homework. Her shrink tracks her progress during the week. Her shrink does that work - not BFF.
The Shrink tried to explain to me one time why he doesn't hold me accountable for homework stuffs. Part of it is that it needs to be my work and not his. The other part is that he assumed if I wanted to go over it, I would say something. Part of it also, though he didn't say as much, is that he had a tendency to forget about it from one week to the next. Now, he takes the time to look at last week before we start and will generally mention what we did last week.
Recently, I have been trying to prepare on Tuesday for Wednesday's session. I make a list of things that have happened or that are bothering me and think them through enough to explain them. I am trying to maximize the benefits I get from therapy. Since he won't assign homework, I try to do a little on my own. I have been trying, too, to stay on task a little closer. The goal is to take something home with me every time. Sometimes that is new insights to something; other times it is something to think about over the week or something to try and do. I don't like walking out of there feeling like it was fun but I learned nothing and planned nothing.
All of this came about when I started comparing BFF's experience to mine, her sense of purpose and focus to my wandering. Before, I just took it at face value. Now I feel frustrated and disenchanted. Is this a sign that I need to just relax and go with the flow? Or that I need to change what I'm doing for/with/about/in therapy? Or that something is wrong in the way my therapy is going?
2 comments:
Wow...what an amazing post. I feel the same way as you about many of the "12 habits"...I really feel that you had an incredible grasp of how therapy works when you said:
"He is human and he has his quirks and, in my book, this is important to me. It's not just acceptable or tolerable, it's a requirement".
To me my pdoc/therapist needs to be himself with me...mindful of boundaries etc., but himself nonetheless...otherwise, if he is perfect, he is outside my realm of understanding. How will he ever understand me, or relate to me if he is a perfect automaton?
I understand envying BFF and her therapist. At first her situation sounds remarkable and I thought...wish my pdoc would follow-up...but your pdoc (and mine) are right when they say it needs to be the patient leading the sessions...otherwise when we leave them how are we going to assume all that responsibility on our own?
Our pdoc's are teaching by example and support...helping us learn to help ourselves. These are much more important lessons.
...aqua
And therein lies the heart of psychotherapy. It must be the work of the patient rather than the work of the doc if it is to be effective.
As for the "human" part, Carl Rogers said it very well. "If I am free to be who I truly am, then the patient is free to be who they really are." (Okay, it's kind of a paraphrase, but the idea is there.)
Post a Comment