First of all: I am not a therapist. I am a patient.
My working diagnosis is bipolar II with some Attention Decificit Disorder (Hypoactive Type) thrown in the mix, a little Hashimoto Thyreoditis (slightly underfunction of my thyroid gland) and two smashed feet, impaired back and wrist due to a suicide attempt from 2015.
As you can imagine I’ve seen my share of shrinks. Psychiatrists, Psychologists, Ergotherapists, Worktherapists… Women and Men. Old and young.
The first time I went to therapy I was 20 years old. It was 2007 and I was struggling after having finished highschool what to do with my life. I was diagnosed as having recurrent depression as I had experienced depressive epsiodes since my early childhood and frequently struggling with suicidal thoughts.
I was always afraid I may have bipolar disease because my father suffers from it forever.
As I was a bookworm I had read already a lot about all kind of mental illnesses, especially about depression and bipolar, before I turned 18. I still read a lot about it, also psychological studies. I always thought it’s interesting. I still do. I even thought about studying psychology myself but I heard that there was too much statistics involved so I decided for philosophy as a minor subject where – among others – we discussed about assisted suicide.
About friends who are psychologists…
However I have two highschool friends who actually did study psychology and are currently about to become therapists themselves.
Actually I even ran into a friend of one of those two friends (who also used to go to our school but I didn’t really know her very well) when I was a patient in a psychiatric ward. I didn’t even know she was becoming a therapist. She probably didn’t know I became a psychopath, either. It was slightly ackward but we said hi anyway. We met several times afterwards watching at our mutual friends house with some more friends the Swiss version of «the Bachelorette».
Oh and my (young and female) therapist at the above mentioned psychiatrist hospital was actually studying with that friend that provided us week after week with a cozy couch, a nice flatscreen TV and amazing snacks to enjoy our bickering about the Bachelorette and her list of more or less interesting pursuers.
And as work is a subject of conversation – even or especially when watching mindless TV shows – I had the privilege of hearing about their professionnal point of view as psychologists.
I can tell you that I heard some hair-raising stories about psychiatry hospitals I wouldn’t believe if I hadn’t been in one. No pun intended.
However I also learned about their problems, their fears before starting a group therapy for the first time, difficulties when they were treating patients older than themselves doubting their competence, the wish to be able to help patients and sometimes the deception when they seem to be unable to to just name a few.
… psychologists that are human…
That psychologists are only human seems kind of logic, but it never really crossed my mind before. Having friends who are training to be psychologists makes this very obvious. They are my friends. Just regular young people, smart, struggling to make ends meet, they like to eat Flammkuchen and drinking a glass of Moscato d’Asti, they watch silly TV together with their flatmates and friends, they wonder about what to say when they go on their first date, they are allergic to pollen, they want to pursue fulfilling careers, meaningful relationships and in general a happy life.
As stated above I was always interested in psychology and even before starting therapy I always examined myself, my past, my present, my future, my thoughts, my illness, my feelings, my fears, my hopes, my life… I have to admit that I am very egocentric (I kind of think that this is normal for people suffering from depression). Not egoistic. But I guess I am quite self-centered.
However psychotherapy is a relationship between two people. I always was thinking mainly about myself (which is porbably normal and even the purpose of therapy in the first place).
I just recently (maybe due to my friends) thought about the people sitting opposite of me in therapy. What is therapy like for the therapist?
Now am totally fascinated by how little I was considering what therapy must be like for a therapist. It just didn’t cross my mind.
That probably sounds stupid, but this is like a whole new revelation for me. Not quite as exciting as when I’ve found out that you can whisk up chicken-pea water together with sugar to get a meringue (it really works!) or when I listen to a wonderful, meaningful new song for the first time and wonder how I ever could live without it before.
Maybe it’s like a blind spot. Discovering something that always has been there but you couldn’t see before, like a tiny birthmark behind your left ear that you’ve never noticed before you had that special three-sided-mirror that allowed you to see things from a new angle.
Or … like a new study field I am interested in.
So I am studying.
I am taking this quite seriously – which almost scares me because I feel I am almost obsessed with it (or is this an early warning-sign of a (hypo)manic phase? or rather hyperfocussing due to ADD? or am I just being a hypochonder and overreacting because I am interested in something new?).
Among others I wonder:
«Why did they become psychologists in the first place?»
«How do they choose the furniture of their office?»
«Do they actually like their clients?»
«How do they maintain their professionnal distance?»
«How does a therapist feel when she looses a patient to suicide?»
«Do most psychologists suffer themselves from mental illness? Would that make them a better or worse therapist?»
«Is a therapist allowed to investigate when his client disappears?»
«Does a therapist asks herself what effect she has on her patients?»
…and psychologists who are not friends…
There are of course thousands of articles on the internet about psychotherapy, therapists, patients… The difficulty is filtering the information you are looking for among all the neglibigle responses. I was also looking for lectures or movies on the subject.
And I found «In Treatment», an HBO Series about an American Therapist named Paul and his patients (which is based on the Israeli serie «Be Tipul»). It deals with a lot of questions from the point of view of the therapist. He also sees his own therapist so we learn about his personal problems and how he feels about his patients, his family and his current therapy.
I finished the first season and I am in the middle of the second one. I like it. Some of the questions I have myself are touched, some new arise. Setting and Breaching Boundaries, Transference and Counter-Transference, The Relationship between the Psychiatrist and the Patient, The Role of the Therapist himself, his past and his own feelings… I am researching further and find new information which makes me tape in new questions that lead to even more answers which of course have to be answered in return… On top I am doing this in three languages – and yes, there seems to be cultural differences in the approaches (not really surprising either).
To be honest I am intrigued by all of this. So many different layers!
As I read about it, for the moment mostly in English, I am amazed by the topics. By what seems to be «the code». Or maybe it’s just what I’ve found so far and it goes all a bit in the same direction.
The boundaries of the relationship of the therapist and the patient are very important. It is a relationship and the success of the therapy depends essentially on it. It may feel intimate, almost like a friendship. But it isn’t. Your therapist is neither your friend nor your potential lover (even though these kind of feelings arise quite often (transference) and are sometimes even mutual (counter-transference) and are normal).
It has to be very clear that the relationship is a professionnal one. What exactly «professionnal» means is of course open to discussion.
There are a few things that seem obvious like whatever the patient tells the therapist is confidential and safe with him. Or that they work together towards the goals of the patient and the therapist supports her client in this. Or that therapists shouldn’t sleep with their patients.
Answer a questions with a question
I am thinking about my different therapists and their approaches.
My very first therapist, a doctor and psychologist whom I remember saying that the opposite of good isn’t bad but well meant (something that stayed with me all those years and the older I get the more I agree with it). This young woman that was in training (as my friends are now) and we did all our therapy sessions in French. The Shiatsu-Therapist that analyzed my dreams with me and told me that my water line was out of balance. The head of the Mindfulness-Course that I appreciate especially because he told me about «Les Emotifs Anonymes», now one of my favourite movies. The female therapist I had seen for about six months – and just a few hours before I tried to commit suicide. The horrible psychologist I had at the first psychiatry hospital. My current psychiatrist who treated me already a few years ago before I moved to the French part of Switzerland.
I can honestly say that I feel they all fulfilled those basic requirements (well the horrible one maybe not so in the way that I didn’t feel supported by him… but I bet he thought he was doing his best).
However when I read further on in the net, some say a therapist should never answer questions. Always conter a question with a question.
And having clear boundaries implies for some that any question about the life of the therapist is completely out of the question. Like if patients would like to know how the therapist feels or if he is married or if she likes Italy, one should always say something like: «Why is it important to you to know…?» or «I see that you are interested in … What would it mean to you if I…?» Personally I think that’s silly. But that may be because I have underlying problems and want to cross boundaries, re-enacting my Odipus-Complex (which I actually think I may very well have) with my therapist to fill the whole of the father figure I never had the way I wanted it.
I suppose there sometime is a certain tendency to overinterpret… Like when patients are late they are trying to tell you something. That whatever they say or do is really meaningful. It’s interesting listening to these theories (also explored in the TV series «In Treatment»), but I don’t think it’s always accurate.
They also should never talk about other patients, not even without mentioning specifics that guard the confidentiality.
Again, I’m thinking about my therapists. I think the ethic discourse in Switzerland may be a little bit different. I know for example that my current therapist likes chocolate, has a family, has had other bipolar and suicidal patients und used to be an architect (black turtleneck pullovers included) before studying medicine and psychology and he really enjoys handing out these little cards where the next appointment is noted upon.
I think it helps to build a therapeutic relationship. Yes, it is therapeutic, he is a therapist and I am a patient, but it’s a relationship nonetheless.
I reckon if I couldn’t relate to him at all as a person it would be difficult to establish enough trust to open up. Most of the stuff just popped up in conversation «naturally» – or at least it felt natural to me. Like in «I understand your sister’s anger. My wife hates it when my children or I walk into the house without leaving the shoes outside!»I think it’s good to know he has had other patients suffering from the same disease as I do. «I had a bipolar patient once who did… can you relate to that?» It gives me some perspective, what others are struggling with and how they can get better. It makes me feel that he knows what he’s doing. I think it’s okay if he shares some neutralized information about me (like, a bipolar woman in her 30ies). Changing careers along the way rings a bell with me as it’s always been an important topic in my life.
Okay I find the thing about the appointment cards quirky. However it’s exactly the kind of thing that keeps me going back to him.