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  1. #1
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    How much information a therapist needs to help

    From: A Guide to Psychology and its Practice - Question and Answers

    How much information does a psychologist need to know in order to help a patient? What is important and what isn?t?

    When Sigmund Freud started practicing psychoanalysis, he essentially told his patients to lie on the couch, start talking, and say whatever came to mind without censoring anything. This was called free association, and it made the question of what to say during the treatment totally unambiguous: everything.

    Now, if you happen to be in psychoanalysis today, the same rule about free association still applies. If you happen to be in cognitive-behavioral therapy, you don?t have to worry about what to say because the psychotherapist will tell you exactly what you have to do and how to think. But if you are in psychodynamic psychotherapy, then you face the dilemma of what to talk about in each session. And for many new clients, this is a real dilemma, because they have to confront not just the question of what to say but also the possibility of what to leave out. Thankfully, a good psychologist can see through all of this. And so it can be said that even in spite of yourself the truth will come out. You just have to be committed to allowing it to happen, despite your fear of the consequences.

    Consider the following example which illustrates how a casual?and seemingly meaningless?comment can be the opening into a major psychological conflict:


    ?I?m really rushin? today,? said one of my clients, standing up eagerly as I greeted him in the waiting room. Then, as we walked down the hall to my office, he looked back over his shoulder to me and added, with a sort of self-satisfied smile, ?I only had three minutes for lunch.?

    In the office, I sat down, musing. A smile came over me, and I said, ?This might seem like it?s off-the-wall, but tell me?who do you know who?s Russian??1

    His face twitched in surprise. With a shrug, he said he couldn?t think of anyone. But I knew the gears were turning. Then, after a long pause, during which I waited in silence, he said, ?Well, there?s my uncle; he was Russian.?

    I asked him to tell me a bit about his uncle, and it turned out that the uncle had willingly made a very profound, spiritual choice about his life many years ago.
    Now, at the time, my client was struggling with many decisions about his own life and vocation, and he was almost at the point of realizing that he wasn?t a victim in life and that he had the responsibility?and the freedom?to choose his destiny. Although he would have preferred to live in all the denial of the mindless rushing around, it slowly started dawning on him that he had to start making some serious and responsible choices about his future. And, believe it or not, that unconscious realization found its symbolism in the Russian uncle who made a free and willing choice of his own many years ago. Our discussion of his uncle, based on that flip comment at the beginning of the session, led to a deep examination of his current emotional struggles.

    This illustration, then, leads us to one key point about psychotherapy: something that you think is meaningless can hold a profound image of your life?s meaning at that moment, and something you think is important can be just a distraction. So how do you, the client floundering in the midst of all this confusion, know what is important? Well, you can?t. Then how do you bear the anxiety of sorting it out? Well, just remember that psychotherapy is not like the adversarial legal system where anything you say can and will be used against you. Good, competent psychotherapy has only one purpose: to help you get close to the unconscious experiences that you have been running from all your life. If you accept this premise, then you can relax a bit, for anything you say in psychotherapy can and will be used to help you. It requires only that you be willing to be honest with your psychologist?and yourself. The being honest will come with training and experience through the psychotherapy itself.

    ___________
    1. Russian and rushin? (rushing) sound the same in English. Word plays such as this can often reveal significant points of unconscious connection.
    ~ our greatest glory is not in never falling, but in rising each time we fall - confucius
    ~ it is the journey, not the destination, that matters
    ~ keep hanging on, the sun will come shining through for you again

  2. #2
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    Re: How much information a therapist needs to help

    If you happen to be in cognitive-behavioral therapy, you don’t have to worry about what to say because the psychotherapist will tell you exactly what you have to do and how to think.
    So it's basically like going to a class?

  3. #3
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    Re: How much information a therapist needs to help

    no, i don't think so. that statement actually sound a little odd now that you've pointed it out. i think what the author is trying to say is, it's not up to you to figure out what to say in session; rather, just talk about what comes to mind and the therapist will guide the discussion from there.
    ~ our greatest glory is not in never falling, but in rising each time we fall - confucius
    ~ it is the journey, not the destination, that matters
    ~ keep hanging on, the sun will come shining through for you again

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    Re: How much information a therapist needs to help

    It just sounds like you don't get to choose what to talk about and having someone tell me exactly what I have to do and how to think brings up a rebellious side of me.

    I guess I really don't understand cognitive behavioral therapy. It seems rigid and controlling.

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    Re: How much information a therapist needs to help

    I dont think that they are saying that the therapist is going to choose what you talk about and tell you exactly what you have to do or else. I think that the therapist is able to help you if you are unable to know what to talk about in a particular session and will also help guide you to what steps need and can be taken by you in order to heal.

    I think most therapists leave the session in your hands and go with the flow of what you want to discuss and will help you with suggestions along the way. That has been my experience lately and have never felt that it is rigid and controlling.

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    Re: How much information a therapist needs to help

    But it does say this

    If you happen to be in cognitive-behavioral therapy, you don?t have to worry about what to say
    What exactly does that statement mean? It seems like the goals of CBT are more rigid and controlling than other types of therapy and this may be due to insurance constraints in some cases or something else.

    That statement is confusing because it implies you don't get to choose what to talk about.

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    Re: How much information a therapist needs to help

    Actually, you don't have to worry about what to say in ANY form of psychotherapy. Part of the therapist's role is to help you say what you want to say and to guide you when you're not sure what to say.

    It's not a matter of not being able to choose, It's a matter of saying, "Don't worry about it". Most people in therapy aren't sure what they are going to say before a session begins. Between you and the therapist, it will all unfold as the session progresses.

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    Re: How much information a therapist needs to help

    I think I got fixated on the phrase "the psychotherapist will tell you exactly what you have to do and how to think." I've been reading more about CBT and trying to grasp the concept of it. It's hard for me to understand things a lot of times, but I keep trying.

    My therapist is pretty good about filling in the blanks with me. He seems to understand me better than I do. I am the failure in therapy because I think I make it hard for him by not opening up as much as I should. I don't know what is wrong with me. I am becoming more and more frustrated and angry at myself as time goes on. And it's scary, this anger.

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    Re: How much information a therapist needs to help

    janet, you can't be a failure in therapy. you're there for you, and your therapist is there to help you deal with things, and sometimes things are just too hard and you're not ready for them. that's perfectly ok. i don't believe any person can BE a failure in therapy. i think a person's therapy can fail, for whatever reason (incompetent therapist, person not really interested, or whatever), but the person themselves is not a failure in therapy. it isn't a contest or an exam, it's about healing, and getting help with the healing.
    ~ our greatest glory is not in never falling, but in rising each time we fall - confucius
    ~ it is the journey, not the destination, that matters
    ~ keep hanging on, the sun will come shining through for you again

  10. #10
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    Re: How much information a therapist needs to help

    Quote Originally Posted by ladybug View Post
    janet, you can't be a failure in therapy. you're there for you, and your therapist is there to help you deal with things, and sometimes things are just too hard and you're not ready for them. that's perfectly ok. i don't believe any person can BE a failure in therapy. i think a person's therapy can fail, for whatever reason (incompetent therapist, person not really interested, or whatever), but the person themselves is not a failure in therapy. it isn't a contest or an exam, it's about healing, and getting help with the healing.
    Very well said, LB.

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