Calling a therapist

People mostly call psychologists (or any shrink, for that matter) when they're in trouble. It's because they have made a mess, or because someone intimately involved in their life has made a mess. What do they think we're supposed to do?

A few months ago a new patient is overwhelmed by grief in my office because she has just found out her husband has had an affair. "Lady, I can't fix that!" I want to say, but she already knows that. She just wants someone to bear witness to her unhappiness, to have someone say to her "That's a shame. I'm sorry you're hurting." Hearing that won't fix anything, but somehow she will feel validated in her misery.

Where are the friends and family that should be standing witness to this sort of event? We've become so fragmented that we seem to have lost our natural support systems, and we're reduced to hiring a sympathetic ear to make real what has happened to us. Maybe the young people with their cell phones and instant messages have the right instinct. Maybe out of the deep human need to escape isolation they are re-creating their own tribes.

My job as a psychotherapist is to help people change. The absolute worst time to try to make a considered and thoughtful change is in the midst of a catastrophe. Granted, a catastrophe, especially one that you create yourself, establishes a dramatic context for the necessity of change, but nobody can think clearly while overwhelmed with misery, desperation or grief. To know what you want to change requires that you know who you are. You have to start from where you are, not from where you want or ought to be. That requires clear thinking, not desperate emotionality. "The court told me I have to see a psychologist" is possibly the worst possible starting point for anything useful.

The function of truth in therapy: Comments on Kaiser

Helmuth Kaiser's theory was that therapy occurred when at least two people were together and at least one of them said what s/he meant and meant what s/he said. He believed that people pretended to understand one another rather than accept the total separateness and isolation of their lives.

While I believe there is some validity in the first statement, I'm not at all sure about the second. Suppose, for instance, that there is a therapist (I'll use male references) and a patient. When the therapist "says what he means and means what he says", who changes? One? Both? Imagine now that the therapist spends the entire hour talking "truthfully" about himself. How could that possibly be effective treatment for the patient? On the other hand, how can the therapist induce the patient to say what he means and mean what he says?

Instead let's look at the issue from a standpoint I have proposed in previous notes. When the therapist gives a truthful response instead of following the social rules, s/he destabilizes the situation. That is, by breaking out of the social role and responding authentically to the patient, s/he makes it possible, or even necessary, for something new to take place. Now the patient can think and say something new, something that is not a social cliche or a comfortable lie. Of course the patient can invent new lies, but that takes a great deal of creativity and is hard to sustain in an ongoing interaction.

So I think the therapist moves the therapy along by speaking the truth, however uncomfortable, by saying what he means and meaning what he says, and thus makes it possible for the patient to think of himself in a new way, one that is more honest. This can be an uncomfortable process, certainly an anxiety-provoking one. (There are many examples in the "Dishonesty Dialogues.) When I pay attention to my interactions with other people, it is astonishing to me how much of the time I hide behind socially acceptable lies. If I tell the truth in social situations, however, no matter how tactfully and kindly, it doesn't take long for the room to empty and for people to find more comfortable and less challenging conversations. But the few that stick around or come back for more are worth getting to know. When I tell the truth in a therapy session, the patient is freed to change, think, get more in touch with himself, make his meanings and words fit together.