Saturday, April 2, 2016

The Folly of Therapy - April Fool's 2016

Welcome to my 11th annual April Fool’s observance. I have to admit that it’s felt like an extra-foolish year for me this past year and I can’t really tell if that’s a good or bad thing. Feeling wise makes me feel confident, but I tend to I get worried if I’m walking around feeling too confident. I like a little insecurity to keep me on my toes. However, if I judge myself foolish for too long, all that insecurity becomes tiresome and kind of a bummer. So, what I tend to do, is dance back-and-forth between self-assured and self-doubting, and that dance seems both wise and foolish in its own ways. I suppose I began this April Fool’s observance as a way to share this paradoxical dance of affirmation and rejection with you, in hopes that you’d recognize it in yourselves, and I’d get to see you recognize it in yourselves, and then I’d feel a little better about doing it myself. Does that make sense?
All that being said, my speech this year is titled “The Folly of Therapy,” and it’s about 12.5 minutes long, which is far longer than a therapist is usually supposed to talk, so thanks for indulging me. I realize that my title leaves open whether I’m going to talk about the folly of being a therapist or the folly of going to therapy. Well, I’m going to continue to break therapist rules and talk about myself for a while, and then we’ll get to you if there’s time, ok?
        My goodness, where to start? I’m feeling lost. Actually, let’s start with lostness-- my supervisor has encouraged me to feel lost with my clients. “Getting lost” with the client feels very foolish, and it’s the opposite of how I pictured doing therapy. I used to picture my client inside a hedge maze, with myself standing on a platform over the maze, and from this vantage point I’d be able to help them form a mental map and find a way out. Doesn’t that sound helpful? Plus, it makes sense to get trained to do this-- you’re having trouble with the mind, I’m trained to know my way around the mind, and so I show you the way. Instead, what, I’m supposed to climb down into the maze?! When I do that, I look around with them, and I say, “Dang, we’re really lost, huh?” And when I do this, I do not feel helpful. I feel foolish. If you’re lost, how could I help by joining you?
        Of course, the image of me standing over the maze is equally foolish. I can’t realistically expect to be the expert on someone else’s life or an expert on life, period. So, where does that leave me, in my maze metaphor? Instead of standing above, I join someone in their maze, but they are the host and I’m the guest, and I need them to show me around. This sounds like what my supervisor is telling me to do, but I still can’t see how it helps. This is my first paradox of therapy: that I am getting graduate-level training just so someone coming to me for help will be told that they are, in fact, the expert.
        If I am to learn my way around another person’s mind, I need to listen, which brings me to my second set of paradoxes, about listening. Early on in my training, I realized that, in switching from teaching to therapy, my professional ratio of talking to listening flip-flopped. Learning listening has led me to feel foolish in several ways, so let’s talk about listening for a little.
        Here’s my understanding of the basics of listening: first, don’t talk. Second, pay attention. Third, don’t get distracted. This seems simple enough, right? Well, it isn’t. Let’s talk about the instruction to pay attention. Pay attention to what? Obviously, I have to pay attention to what the client is saying, and that’s the easy part, because it’s coming right out of their mouth. At the same time, in my head, I also have to pay attention to any patterns I notice in the thoughts and feelings they share, and this higher level of listening can get a little distracting. But a little multi-tasking is to be expected, right? Sure. Listen to what they’re saying, and listen for the patterns. This is fine, until my supervisor tells me to listen to what the client is not saying. What?! Do you realize how many things a person is not saying at any given moment? Are you hearing what I’m not saying right now? Of course, my supervisor’s advice is wise-- I’ve had clients who suffer insult after insult but never mention feeling angry; I’ve had clients who tell me all the ways they try to escape emotional pain but never talk about the pain. What the client doesn’t say is crucial. As a therapist I have to listen to everything said and everything left unsaid.
        Now let’s talk about not getting distracted, which really is just the contrapositive of paying attention. Suppose a client starts talking about something, and I find myself thinking about my own similar experiences. Or I think about how I’m feeling right now. Or I start thinking about dinner. Distractions, right? Except!! I then need to ask myself why I’m having the thoughts or feelings I’m having, and listen for the answer, as it may tell me something about the client. Even distractions, then, must be listened to. Do you see how listening fully is paradoxical and ridiculous? I have to listen to everything said and unsaid, from the client and within myself.

        And for all that, the hardest part about listening as a therapist has been trying not to think about what I’m going to say next. This is generally a good practice for all listeners, but in conversation or therapy it’s actually tricky advice to follow. If I’m not thinking about what to say while they’re talking, when do I start thinking about it? After they stop talking? Think of the silence! I’m not so concerned about the awkwardness, but more about the ambiguity of silence-- a delay in response could indicate to the client that I wasn’t listening, that I didn’t understand, that I’m overwhelmed, that I’m clueless, or even that I’m judging them. And, some of those assumptions might even be true.
        Trying to think about my response brings me to my third area of paradox in therapy, which is the tension between authenticity and theoretical orientation. After listening so fully, how do I choose what to talk about? In the course of my education and training, I’ve been told that a theoretical orientation can make listening easier because it defines what is most salient in the client’s words. As a Freudian I would listen for early-life experiences. As a cognitive therapist I would listen for distortions in thought. Other orientations might guide me just to listen for tone of voice and body language. Other orientations tell me to listen for what the client thinks is important. I hope you see how any orientation will help me filter through everything that’s said, and in doing so, will keep me from listening fully. But, hey, at least an orientation gives me some sense of what to say next.
        However, it can seem like an orientation gets in the way of authenticity. Common wisdom in counseling tells us that, more than any particular orientation, the client is helped by experiencing an authentic and caring relationship with the therapist. After all this training, however, authenticity feels impossible! A good therapist doesn’t interrupt, doesn’t give advice, and doesn’t judge; but, authentic Matt Lowe does do all those things. Instead, I’ve been learning to sit patiently, ask questions, and try to discover from the client what they believe is my role in helping them achieve whatever they believe is their goal. I want to believe that this way is more helpful than my philosophical guru approach, but I also wonder how I’m supposed to feel and act authentically when adopting such a constructed role in therapy.  This effort towards a constructed (and thus artificial) authenticity makes me feel foolish.
        Ok, this is going long, as it often does. I’ve talked about the paradoxes in joining the client, listening to the client, and being authentic with the client. All of these realms, and all my concerns about them, are involved in what is really my ultimate question about being a therapist: What does the therapist do that truly helps?
        My supervisor tells me that the relationship heals, not the conversation. This observation is probably true, but I don’t know what to do with it, since I only know how to develop the relationship through the conversation. He tells me to listen for the quality of the relationship; again, good advice, but that’s yet another level of listening that I’m barely understanding.
        I think I’m starting to understand the key paradox at the heart of my development as a therapist, and it lies in the tension between analysis and presence. Freud called his approach to therapy “analysis,” and that word says a lot about his role and relationship with clients-- he’s the expert, and they and their problems are objects to be analyzed. As someone who loves philosophy, I love the idea of analyzing, and I thought becoming a therapist would be a way to use my analytical skills to help others. This is not wrong, but it’s becoming clear that it’s not enough. Let’s return to my original metaphor of the client as lost in a maze; I had thought that my folly lay in thinking of myself as the expert of the maze, but now I’m realizing that the image itself may be what’s foolish. To analyze is to problem-solve and to problem-solve is to help someone move from here to there; the client is trying to escape the maze. But, is that what therapy is about?
        Here are some other metaphors to describe therapy. First, let’s consider therapy as the game Tetris. In this metaphor, the analyst shows the client how all their pieces fit together and, amazingly, once they’re all fit together they disappear! To mix my metaphors here, the master of Tetris is also great at packing luggage or, as it’s called sometimes in mental health, baggage-- the master of Tetris knows just how to pack away all the baggage, and once it’s packed, they can shut the door and go on their merry way. The analyst as master of Tetris seeks to understand the space, to understand the pieces in the space, and to explore the many possible configurations of those pieces, to see how best to fit them together. In this image, the analyst is the problem-solver, is the expert, listens for specific elements, and is required to be efficient rather than authentic.
        And this entire image is missing the key element of therapeutic presence-- presence is the element through which the therapist is a guest, the therapist listens openly, and the therapist must be authentic. So here’s a different metaphor:

        Let’s consider therapy as the art of interior design. Wikipedia tells me that “interior design is the process of shaping the experience of interior space,” which, c’mon, that’s a fantastic metaphor for therapy. The interior designer, like the Tetris master, must consider the space, the objects, and the arrangements, but the interior designer must consider all of these things in terms of the need to live in that space. The client is not lost in a maze; the client is trying to be at home in a place that doesn’t feel like home. The only way to help is to join them, to learn what “home” feels like to them, and to help them make that home. And the space is not just the client’s own mind, but also their relationships, their plans, their past, and all the other realms of their reality. This sheds light on my supervisor’s statement about the relationship as healing-- the therapeutic relationship is a place for the client to practice making a home and feeling at home. The therapist helps by bringing their own presence into the relationship, by focusing on cultivating presence so that the client can arrive and feel able to be present. Analysis helps move the furniture, but only presence can confirm that a space has become livable.

        Well. Um. That was quite a little flight of fancy, wasn’t it? It sounds good, even though I have little to no practical thought about how to do such work. Another foolishness I feel a lot this year is from recognizing the gulf I regularly experience between theory and practice. Um. Tell you what. I’ll summarize, and then ask and answer one last question.
        The therapist is the expert who must join you so that you’re the expert. The therapist is the full listener who listens to everything said and unsaid and then must speak. The therapist is the authentic person who listens through the filters of various theoretical orientations as they are needed. The therapist is the master of Tetris. The therapist is the interior designer. The therapist is a fool.
So the question is: Why would you want a fool for a therapist?
        You want a fool for a therapist because a fool can’t show you the way, and anyone who can show you the way is showing you their way, not yours.
        You want a fool for a therapist because a fool doesn’t know how to listen like an expert or respond like an authority, and experts and authorities see their field of expertise but they don’t see you.
        You want a fool for a therapist because a fool cannot help but be authentic because it takes too much cleverness to be someone else. The fool is the foreigner who humbly learns from the natives, and the fool is the foreigner who sees what the natives miss. The fool is regularly disoriented and so regularly struggles to become oriented; this makes the fool a good companion.
        You want a fool for a therapist because it feels foolish to want to help without knowing how to help, so a fool will join you no matter what—and presence, I’ve heard, is the key to helping.
        Thank you.