Saturday, May 18, 2013

Empathy, Improvisation and the Growth of the Therapist

a continuation of On Getting Unstuck



Therapists, more often than they wish, find themselves trying to be empathetic with people they would not otherwise spend time with.  This often means being open to the thoughts and experiences of very difficult people who may have been terribly damaged and grievously hurt. This necessary attempt at an empathic engagement often evokes the therapist’s own vulnerability, the sort of feelings one would not open up or consider except with trusted companions. Especially for the new or young therapist, this confrontation with vulnerability has important consequences. Simply asked, does the therapist acquire a greater capacity for toleration and self-reflection, or close off and avoid what is too tender and painful to acknowledge? In my own practice, I know I have done both. This is an important lesson I offer my students; it remains a work in progress for myself, a vital concern of theirs.

I start the lesson, hopefully enough, with the promise that the work they will do will make them better people. A more honest correction, with its attendant "unless clauses”, will come later. Not all of them will mature with an increased toleration and capacity for understanding, but many will. Most will discover where this growth is possible and desirable and where it is not.  If they are lucky and careful, this self-knowledge will help guide their careers.

Why do I confidently start with the claim that the ordeal of conducting intensive psychotherapy will make the therapist a better person? Again, simply put, because to engage in such a relationship, to accept the openness to the other that therapeutic improvisation requires, necessarily means both participants, the client and the therapist, will change.  Both will acquire a degree of new competence and knowledge that would not have been achieved had they not entered into this otherwise unlikely arrangement.  At least for the therapist, there might have been no need to.

I have seen data that indicates that an important outcome of psychodynamic psychotherapy is that the client becomes somewhat more insightful about him or herself, considerably more insightful about their intimates and neighbors, and generally more tolerant.  I am sure this is the case for all of the intensive, non-directive therapies where the therapist is deliberately mindful about being judgmental. Therapists become experts in the many ways a person can be accepted or degraded. Clients become aware of this beneficial attitude and method of understanding and may acquire the ability to practice it with themselves and others. I think it is reasonable to say the world is a better place when this is possible.

I am suggesting that therapy improves the world. In an intensive psychotherapy, the client learns how to handle difficult emotions, relationships and thoughts, because they repeatedly practice this in the company of their therapist.  The therapist’s non-coercive and empathetic attention to the boundaries of toleration make this practice possible. The client becomes more competent in thinking over difficult issues.  If the practice is sufficient, the client is now in a better position to make informed choices with less desperation, or perhaps no desperation at all.   Basically, the client achieves the needed skill to manage and accept what does not actually violate their integrity, now knowing what is real violation and what is not.

I think this holds for the therapist as well, and makes some therapists, over time, better people. Therapy’s required openings, this necessity to affirm and incorporate an exploration of suffering and difficulty into an ongoing improvisation, means the therapist has encountered and handled something difficult they might have avoided. By not escaping into avoidance, the therapist develops empathy and compassion and becomes a better person.  



Therapy, as I understand it, requires cultivating and tolerating what I think of as a sort of Mindful Uncertainty. 



6 comments:

  1. Thank you Dr.Schwartz for this enlightening post! As a student, reading blogs like this one puts us at ease, at least it did for me. Your blog reminds me of a client I see on a weekly basis. She is a Caucasian, bisexual, divorced, middle-aged woman whose past is filled with trauma, sexual, psychological, and physical abuse by her ex-husband. Her characteristics and background cannot possible differ more in comparison with mine. How can I, being the complete opposite of her, possibly even begin to relate to her situation?

    What you say above rings true for me, "In an intensive psychotherapy, the client learns how to handle difficult emotions, relationships and thoughts, because he or she repeatedly practices this in the company of the therapist. The therapist’s non-coercive and empathetic attention to the boundaries of toleration make this practice possible". Although I cannot relate to her past, I can be (and certainly am) non-coercive and empathetic during our sessions together. At the very least, I am there to listen to her and bounce ideas off of her. But, in a different way, I also encounter something difficult every time we see each other. However, I don't escape the situation. Me feeling very uncomfortable at times while hearing her stories and helping her express her bottled up feelings will not only eventually make me a better person and grow as a therapist, but most importantly, will make my client a much healthier and happier contributor to society.

    ~ G. Cruz

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    1. "Me feeling very uncomfortable at times while hearing her stories and helping her express her bottled up feelings will not only eventually make me a better person and grow as a therapist, but most importantly, will make my client a much healthier and happier contributor to society."

      It might. But because it might, we try.

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  2. I found this blog post to be especially interesting. I am interested in the client-therapist relationship, but it seems that we often discuss how our interactions in therapy affect the client rather than the therapist. This gave a unique twist on a common topic, and I like the claim the therapists become better people after engaging in longterm psychotherapy with clients.

    I have a few clarifying questions and thoughts relating to this post. Would you make the claim that therapists become better people (in general), or better overall therapists after enduring intensive longterm psychotherapy? Would the skills they've learned during this interaction extend into their personal lives? If so, is this always beneficial to the therapist? Although further developing empathy and compassion seems great, I can imagine that it is not always that simple and may complicate personal relationships. Additionally, do you recommend therapist engaging in their own form of psychotherapy during this longterm intensive treatment with a client? The client is able to work with the therapist as he or she changes, but who does the therapist talk with about his or her own personal growth?

    -Tara G.

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    1. A couple of thoughts.

      A question of the sort that involves "is it always?" is almost always answered, "no".

      About how doing therapy can complicate the therapist's own relationships? I am sure it does, but I'd like to know more of your thoughts on this.

      Regarding whether I recommend therapists having their own long term therapy: I see it as a necessity. It is a requirement in psychoanalytic training, but regardless of modality, I would never knowingly refer someone to a therapist who hadn't had their own extensive insight oriented therapy. Knowing oneself and what we bring to the table should be a requirement for doing this work.

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  3. Your description of a more empathetic future and a subsequently improved personhood are inspiring to the aspiring psychologist. I believe that all practicing therapists, at some or many points in their professional careers, experience some difficulty in feeling true empathy for certain patients. In reflecting on my own short clinical history, I am reminded of a multitude of times in which I have struggled to achieve true empathy for my patients, particularly in times in which they have disclosed behavior that I find appalling or morally unsound, or in moments in which a patient may fail to demonstrate any remorse for doing harm to others or wronging society in general. What aids me during such moments of "failure-to-empathize" are the words of a former professor, which I repeat to myself when such situations arise: "At one point, the person in front of me was somebody's baby and something went terribly wrong." These words form a mantra that not only reminds the clinician of the dignity and love that all individuals deserve, but also challenges him to utilize empathy in order to create positive change in the life of the person in front of him.

    That being said, achieving a desired sense of empathy sometimes takes more work that one would hope. Practice may not always make perfect, but I genuinely appreciate your above lesson, which suggests that practicing empathy may, at the very least, make one a better person. Now that's something to work for...

    -R. DiGiammarino

    -R. DiGiammarino

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  4. Pat Aucoin, Ph.D.March 2, 2015 at 4:07 PM

    Another day in the life of a therapist (or analyst) - how can he or she assist this client? Given knowledge of Descriptive Psychology, the therapist has an edge - this client is a person, as such, his or her behavior is under the auspices of the Person Concept, and it makes sense in that context. That gives the therapist a framework to work with. In the drama of the client's life, choices have been made, circumstances and statuses have existed, and some if not all of this has not been beneficial (taking into account Existentialists saying that episodes of meaninglessness can make us stronger). Now new dramas involving the therapist and the client are about to begin as therapy starts.. Each has taken on the other as a prop, or supporting actor, in his or her drama.
    Perhaps what has just been said could provide a context for the issue of empathy. During the client's life, he or she has produced behavior based upon a choice of an example from each of the concepts that he or she has. A concept may be terribly deficient (I am nothing but trash and I can't imagine myself as anything else, or, I'm better than you - you would be a homeless bum if some fool hadn't given you this job) or the choice of example from a concept may have misfired. At the risk of oversimplification, the therapist could keep in mind that while these concepts and choices may seem offensive, the client, as a person, has the potential to turn out differently. Wynn, I hope this helps support what you have stated. - Pat Aucoin, Ph.D.

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