What makes your therapist great?
June 26, 2012 3:05 PM Subscribe
Are there unique and non-obvious things your therapist does that have been helpful to you?
I asked this in the past but it was deleted as chatty, so let me make it very clear why I am asking: I am a young therapist in training and I'm hoping to consider my own practice through these answers. I am interested in hearing what skills, demeanors, and behaviors of therapists have been meaningful and helpful to you, beyond the basic necessities (nonjudgmental, empathetic, compassionate, insightful, good listener).
For example, I have a friend who said it meant a lot to her that her therapist remembered the anniversary of her divorce. I have another acquaintance who was blown away when his therapist looked up a community center option for his elderly non-English speaking mother. I have a third friend who said her therapist helped her laugh for the first time about a childhood memory that had plagued her with shame for two decades. Things like that.
Yes, I'm developing my own style. No, I'm not planning to just gather other professionals' practices and emulate them. But I'm interested in what gestures or practices have conveyed real care and helped formed connection, or have spurred real change in ways that may not be intuitive.
Thank you!
I asked this in the past but it was deleted as chatty, so let me make it very clear why I am asking: I am a young therapist in training and I'm hoping to consider my own practice through these answers. I am interested in hearing what skills, demeanors, and behaviors of therapists have been meaningful and helpful to you, beyond the basic necessities (nonjudgmental, empathetic, compassionate, insightful, good listener).
For example, I have a friend who said it meant a lot to her that her therapist remembered the anniversary of her divorce. I have another acquaintance who was blown away when his therapist looked up a community center option for his elderly non-English speaking mother. I have a third friend who said her therapist helped her laugh for the first time about a childhood memory that had plagued her with shame for two decades. Things like that.
Yes, I'm developing my own style. No, I'm not planning to just gather other professionals' practices and emulate them. But I'm interested in what gestures or practices have conveyed real care and helped formed connection, or have spurred real change in ways that may not be intuitive.
Thank you!
When I was dealing with an issue somewhat beyond the scope of my therapist's practice, she talked to her colleagues and got a great book recommendation for me. When I moved temporarily to a new city, she reached out to her contacts to find me another therapist in that area. I was touched that she did the extra work outside of our sessions to research options to help me. (A caveat, though — if you are young and just starting out, I think there would be a fine line between looking thoughtful/helpful and looking clueless.)
posted by adiabat at 3:14 PM on June 26, 2012
posted by adiabat at 3:14 PM on June 26, 2012
The best therapist I ever had was in college. The reason I loved him was because he paid attention on my intake sheet to what I was academically interested in -- philosophy -- and incorporated it into my treatment. It helped me relate to the world outside his office as I worked on myself (important in the treatment of social anxiety). It also felt very geared to me as an individual. It was never a "let me give you general encouragement and/or nod for 50 minutes" sort of session, but a personal session that was engaging to me intellectually as well as emotionally. In fact, I learned by having him as therapist that being intellectually challenged is a very important part of healing for me.
It's hard to describe, but I guess the short of it is that I liked that he payed attention to the type of person that I am and geared my therapy appropriately.
posted by houndsoflove at 3:32 PM on June 26, 2012 [10 favorites]
It's hard to describe, but I guess the short of it is that I liked that he payed attention to the type of person that I am and geared my therapy appropriately.
posted by houndsoflove at 3:32 PM on June 26, 2012 [10 favorites]
Good therapist practice: Let me choose where to sit in the office, and had the good sense not to block my path to the door.
posted by Iris Gambol at 3:39 PM on June 26, 2012 [8 favorites]
posted by Iris Gambol at 3:39 PM on June 26, 2012 [8 favorites]
and had the good sense not to block my path to the door.
This. Was, in general, utterly non-judgemental about my fear of being trapped.
posted by small_ruminant at 3:42 PM on June 26, 2012
This. Was, in general, utterly non-judgemental about my fear of being trapped.
posted by small_ruminant at 3:42 PM on June 26, 2012
I saw a very impressive psychiatrist years ago, briefly because she was so effective. She was not kind and friendly at all. If anything, I'd describe her emotional tone as chilly to cold. But she had three great qualities. First, she was extremely direct. Second, she listened extremely well -- she just never misremembered or lost attention. Third, she was very smart.
You should be yourself, but based on that I'd suggest you aim to apply your best intelligence to analyziing what your clients tell you, to listen with complete attention, and to be as direct and straightforward as you can.
In terms of office arrangement, I think it should be about the patient. So keep your own stuff out and make sure the space is neutral, comfortable, quiet and private.
posted by bearwife at 3:42 PM on June 26, 2012 [5 favorites]
You should be yourself, but based on that I'd suggest you aim to apply your best intelligence to analyziing what your clients tell you, to listen with complete attention, and to be as direct and straightforward as you can.
In terms of office arrangement, I think it should be about the patient. So keep your own stuff out and make sure the space is neutral, comfortable, quiet and private.
posted by bearwife at 3:42 PM on June 26, 2012 [5 favorites]
When I was in college, I was in a difficult relationship with someone. I was home for the summer, and I was seeing this one therapist who had been recommended to me. I liked comic books at the time (and I still do), so one time she had me photocopy two pages out of one of the books that I had and had me substitute the characters' dialogue with an imagined dialogue between myself and the person I was having issues with. It really got me thinking about the interpersonal issues between myself and that person, as well as my expectations about how any such conversation would go. As someone who had always had trouble with interpersonal stuff, that exercise really helped.
My current therapist has me write in a notebook a lot, since she knows I think better a lot of the time when I write stuff out. She has also given me a few awesome book recommendations, and even referred me to one of her colleagues when she was away on vacation. It seemed small, but it really helped me.
posted by bookwibble at 3:45 PM on June 26, 2012 [2 favorites]
My current therapist has me write in a notebook a lot, since she knows I think better a lot of the time when I write stuff out. She has also given me a few awesome book recommendations, and even referred me to one of her colleagues when she was away on vacation. It seemed small, but it really helped me.
posted by bookwibble at 3:45 PM on June 26, 2012 [2 favorites]
This may sound strange, but I was glad my good therapist wore chain-store clothes much like mine. She dressed nicely but without much expense despite being in private practice. It made me think she was more interested in substance than style and that helped me trust her.
My bad therapist was all haute couture and bling.
posted by Kerasia at 3:47 PM on June 26, 2012 [7 favorites]
My bad therapist was all haute couture and bling.
posted by Kerasia at 3:47 PM on June 26, 2012 [7 favorites]
Mine periodically changes up the visual art on the walls.
I appreciate both the simple change because, jesus, one spends what seems like hours staring at and into the art on one's therapist's walls), and the non-judgemental recognition that clients talking and staring at a piece of art is sometimes easier than even talking to the therapist. The subtle postscript to me, whether or not he means it, is that even if you are staring in the same direction, things can change.
posted by rumposinc at 3:51 PM on June 26, 2012 [13 favorites]
I appreciate both the simple change because, jesus, one spends what seems like hours staring at and into the art on one's therapist's walls), and the non-judgemental recognition that clients talking and staring at a piece of art is sometimes easier than even talking to the therapist. The subtle postscript to me, whether or not he means it, is that even if you are staring in the same direction, things can change.
posted by rumposinc at 3:51 PM on June 26, 2012 [13 favorites]
I have two key complexes that interfere with the way I interact with people. One, I am extra sensitive to body language that may suggest that the person I am with is tired of talking to me and/or that I am wasting that person's time. Two, I have a weird relationship with hugs for reasons that are a pain to explain. My therapist always makes sure she gives me her full attention and shows it by keeping her eyes on me and not looking at her watch, and she always asks before she gives me a hug since she knows it's important to me.
posted by Hello Darling at 4:00 PM on June 26, 2012 [2 favorites]
posted by Hello Darling at 4:00 PM on June 26, 2012 [2 favorites]
My therapist's office is decorated with framed prints by Vincent van Gogh. To me, this says that she respects the beauty, individuality, and vision of those challenged by mental illness.
At the beginning of each session, she asks me how I want to use the time and, at the end of each appointment, she asks me whether the session was helpful and, if so, how. This reminds me that we're making meaningful progress every week.
posted by gentian at 4:05 PM on June 26, 2012 [6 favorites]
At the beginning of each session, she asks me how I want to use the time and, at the end of each appointment, she asks me whether the session was helpful and, if so, how. This reminds me that we're making meaningful progress every week.
posted by gentian at 4:05 PM on June 26, 2012 [6 favorites]
The good stuff:
- Asking me what kinds of things (articles, tools, whatever) would help, and then using those. For example, my therapist gave me several different written sources on ADHD because she knows that I prefer mulling over written materials and that I want to come to my own conclusions.
- Not doing stuff once I've indicated that it's not helpful. EMDR was no longer suggested once I made it clear I wasn't interested.
- Providing (and answering) her email address instead of always making me call and leave voicemails.
- Asking my actual opinion and respecting it. My therapist heard me when I said I was an INTJ, and that I don't want to work on issues X, Y, and Z right now, and that I was quite sure that such-and-such would be unlikely to succeed. Me expressing my opinion led to an actual change in the therapeutic environment, and not just nodding and "hmm, yes, I can see how that would feel that way."
- Asking if it bothers me that she swears, and toning it down/eliminating it when the answer was "yes."
- Turning off the overhead florescent lighting and everything that buzzes and whirs and whatever (I have sensory processing issues.)
- Working really really well with other professionals. Today my old therapist (who I'm hoping to go back to) had an extended telephone call with my EAP counselor about my welfare (I'm going back into a partial program.)
- TELLING ME that they're talking about me behind my back. Good golly is it creepy to find that out from the second person, three weeks after the conversation happened. My EAP counselor forwards me emails that are about me, whenever she can. I appreciate this.
- Scrupulously avoiding stereotypical therapy crap. Asking me how I feel something in my body or telling me that you understand that such-and-such thing would be oh so very frustrating are pretty much one-way tickets to me not seeing you anymore.
- Reminding me of stuff when it's obvious I've forgotten. I have problems asking for things; my good therapists have flat-out handed me the tissue box rather than waiting for me to both a) remember a tissue would help and b) work up the courage to get up and get a freaking tissue.
- Letting me use my tangle and color and stuff while I'm stressing out. More applicable to group sessions. I can't begin to describe how helpful I find coloring during group therapy. And having a tangle toy or similar object keeps me from pulling or scratching/biting myself, so yay.
- Using the big scary grown-up psychiatry words rather than treating me like I'm two years old. (Note: this is a me thing more than a general thing; I'm sure that a large subset of patients want things explained using simple terms.)
- Not touching me. Because no, thank you, not ever.
- I agree about the open path to the door thing. It's best if I can be stationed in a corner, so I can see the door and any windows. I've got a remarkable startle response that has frequently alarmed therapists with poorly laid-out offices.
- Fixing the problem being more important than sticking to the book (whatever the book is.) Manualized therapies are really good at being tested in a laboratory setting for the purposes of NIMH-funded studies. I am not a study. If your manual isn't helping me, the problem isn't just automatically with me. (I have one therapist who did this TERRIBLY and one who did it really well.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:11 PM on June 26, 2012 [3 favorites]
- Asking me what kinds of things (articles, tools, whatever) would help, and then using those. For example, my therapist gave me several different written sources on ADHD because she knows that I prefer mulling over written materials and that I want to come to my own conclusions.
- Not doing stuff once I've indicated that it's not helpful. EMDR was no longer suggested once I made it clear I wasn't interested.
- Providing (and answering) her email address instead of always making me call and leave voicemails.
- Asking my actual opinion and respecting it. My therapist heard me when I said I was an INTJ, and that I don't want to work on issues X, Y, and Z right now, and that I was quite sure that such-and-such would be unlikely to succeed. Me expressing my opinion led to an actual change in the therapeutic environment, and not just nodding and "hmm, yes, I can see how that would feel that way."
- Asking if it bothers me that she swears, and toning it down/eliminating it when the answer was "yes."
- Turning off the overhead florescent lighting and everything that buzzes and whirs and whatever (I have sensory processing issues.)
- Working really really well with other professionals. Today my old therapist (who I'm hoping to go back to) had an extended telephone call with my EAP counselor about my welfare (I'm going back into a partial program.)
- TELLING ME that they're talking about me behind my back. Good golly is it creepy to find that out from the second person, three weeks after the conversation happened. My EAP counselor forwards me emails that are about me, whenever she can. I appreciate this.
- Scrupulously avoiding stereotypical therapy crap. Asking me how I feel something in my body or telling me that you understand that such-and-such thing would be oh so very frustrating are pretty much one-way tickets to me not seeing you anymore.
- Reminding me of stuff when it's obvious I've forgotten. I have problems asking for things; my good therapists have flat-out handed me the tissue box rather than waiting for me to both a) remember a tissue would help and b) work up the courage to get up and get a freaking tissue.
- Letting me use my tangle and color and stuff while I'm stressing out. More applicable to group sessions. I can't begin to describe how helpful I find coloring during group therapy. And having a tangle toy or similar object keeps me from pulling or scratching/biting myself, so yay.
- Using the big scary grown-up psychiatry words rather than treating me like I'm two years old. (Note: this is a me thing more than a general thing; I'm sure that a large subset of patients want things explained using simple terms.)
- Not touching me. Because no, thank you, not ever.
- I agree about the open path to the door thing. It's best if I can be stationed in a corner, so I can see the door and any windows. I've got a remarkable startle response that has frequently alarmed therapists with poorly laid-out offices.
- Fixing the problem being more important than sticking to the book (whatever the book is.) Manualized therapies are really good at being tested in a laboratory setting for the purposes of NIMH-funded studies. I am not a study. If your manual isn't helping me, the problem isn't just automatically with me. (I have one therapist who did this TERRIBLY and one who did it really well.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:11 PM on June 26, 2012 [3 favorites]
Thirding not blocking my path to the door. More generally my therapist realized, and was attentive to, the fact I was physically scared of him as a man I was alone with (even though I never mentioned it and tried to be as direct, friendly, and equal a partner in the process as possible). I appreciated his not assuming I had reason to trust him, even though obviously he was trying to build more trust. It made it clear he understood my perception of the world and respected it.
Like houndsoflove and Fee Phi Faux Phumb, I liked my therapists' willingness to work with my intellectual way of viewing the world. Even though we were mainly doing CBT, he was happy to give me reading lists (lists! not just one book, I like to get me money's worth ;) ) about the background for what we were working on, and from other fields of psychology.
posted by pickingupsticks at 4:17 PM on June 26, 2012 [1 favorite]
Like houndsoflove and Fee Phi Faux Phumb, I liked my therapists' willingness to work with my intellectual way of viewing the world. Even though we were mainly doing CBT, he was happy to give me reading lists (lists! not just one book, I like to get me money's worth ;) ) about the background for what we were working on, and from other fields of psychology.
posted by pickingupsticks at 4:17 PM on June 26, 2012 [1 favorite]
When I bring up things I don't like/don't feel comfortable with about the relationship or the therapy, my psychiatrist says, "Thank you for saying this." And listens.
Also, he never talks about his personal life, his political beliefs, or anything else that's all about him and not about me. This might seem obvious, but it's not the norm in my experience. I've had therapists before who were very nice and very dedicated, but one liked to show me pictures of her grandchild and talk about how cute he was. One time when I was critical of my gynecologist, she said, "I wonder what you say about me." Another easily got off the subject and went on for a few minute about insurance companies and the health-care system. Sometimes my doc will tell stories that involve him, but there's always a therapeutic purpose.
Please start on time. More than 10 minutes late feels disrespectful. Again, it's obvious, but you'd be surprised...
Also, my doctore has a lot of art and unusual objects in the office, It gives me something to look at and seems to help me think.
posted by wryly at 4:24 PM on June 26, 2012 [5 favorites]
Also, he never talks about his personal life, his political beliefs, or anything else that's all about him and not about me. This might seem obvious, but it's not the norm in my experience. I've had therapists before who were very nice and very dedicated, but one liked to show me pictures of her grandchild and talk about how cute he was. One time when I was critical of my gynecologist, she said, "I wonder what you say about me." Another easily got off the subject and went on for a few minute about insurance companies and the health-care system. Sometimes my doc will tell stories that involve him, but there's always a therapeutic purpose.
Please start on time. More than 10 minutes late feels disrespectful. Again, it's obvious, but you'd be surprised...
Also, my doctore has a lot of art and unusual objects in the office, It gives me something to look at and seems to help me think.
posted by wryly at 4:24 PM on June 26, 2012 [5 favorites]
My therapist has a lot of fidget objects and toys in his office, including a sand table, and he's not afraid to mix it up/offer me something different to do with my hands mid-session if I look uncomfortable. It's awesome.
posted by PhoBWanKenobi at 4:25 PM on June 26, 2012 [3 favorites]
posted by PhoBWanKenobi at 4:25 PM on June 26, 2012 [3 favorites]
My best therapist did all of the following things:
- Took checks, but didn't cash them until I'd booked (and sat through) my next appointment
- Allowed me to sit and cry and/or fume in silence if I didn't feel like sharing/talking after a certain point; it was my money and my time, after all (but didn't allow this to happen twice in a row, ever)
- Refused to book appointments after she felt I'd achieved the most benefit from our therapy sessions and/or my issue was resolved, though she always said I could pay her back in referrals (this taught me that her goal was to improve my mental health, not earn a paycheck)
- Would speak to me free of charge on the phone to "talk me off the ledge" if she and I both felt it was an emergency, though I tried to be considerate about doing that
- Accepted "mental health check-in" appointments to verify I was on track if I felt things in my life might go pear-shaped; if I was fine and just worrying, she'd shoo me out good-naturedly after telling me so
- Ended every session by reminding me that I was a good person; this was HUGE for me personally, not sure if that would be helpful for, say, narcissists?
- Yes, lots of fidgety/arty/distracting things to focus on in the office during waiting periods and/or difficulty talking about an issue
- Boxes of Kleenex handy on every possible surface; bowls of various types of candy stationed around the office, including sugar-free kinds; no audible phones ringing anywhere in her office (though this may not be plausible for everyone). A self-serve water cooler both in the waiting room and her office, always with plenty of clean cups nearby. No magazines, but plenty of humorous and visually engaging coffee-table books for browsing.
posted by Unicorn on the cob at 4:32 PM on June 26, 2012 [7 favorites]
- Took checks, but didn't cash them until I'd booked (and sat through) my next appointment
- Allowed me to sit and cry and/or fume in silence if I didn't feel like sharing/talking after a certain point; it was my money and my time, after all (but didn't allow this to happen twice in a row, ever)
- Refused to book appointments after she felt I'd achieved the most benefit from our therapy sessions and/or my issue was resolved, though she always said I could pay her back in referrals (this taught me that her goal was to improve my mental health, not earn a paycheck)
- Would speak to me free of charge on the phone to "talk me off the ledge" if she and I both felt it was an emergency, though I tried to be considerate about doing that
- Accepted "mental health check-in" appointments to verify I was on track if I felt things in my life might go pear-shaped; if I was fine and just worrying, she'd shoo me out good-naturedly after telling me so
- Ended every session by reminding me that I was a good person; this was HUGE for me personally, not sure if that would be helpful for, say, narcissists?
- Yes, lots of fidgety/arty/distracting things to focus on in the office during waiting periods and/or difficulty talking about an issue
- Boxes of Kleenex handy on every possible surface; bowls of various types of candy stationed around the office, including sugar-free kinds; no audible phones ringing anywhere in her office (though this may not be plausible for everyone). A self-serve water cooler both in the waiting room and her office, always with plenty of clean cups nearby. No magazines, but plenty of humorous and visually engaging coffee-table books for browsing.
posted by Unicorn on the cob at 4:32 PM on June 26, 2012 [7 favorites]
Some good things: Being on time, apologizing if you're not on time (because you respect me and my time). Noticing when I zone out, and asking me what's going on. Noticing when I get anxious, and asking me what's going on. Noticing when I relax/ get less anxious, and pointing it out to me. These all both signal that she is tuned in to me plus are therapeutically useful.
Some bad things that have happened with previous therapists: Checking her phone during appointments, wtf. Telling irrelevant stories about her children/ herself (which is totally different from telling relevant stories about herself). Being late and not seeming to notice.
posted by insectosaurus at 4:32 PM on June 26, 2012 [2 favorites]
Some bad things that have happened with previous therapists: Checking her phone during appointments, wtf. Telling irrelevant stories about her children/ herself (which is totally different from telling relevant stories about herself). Being late and not seeming to notice.
posted by insectosaurus at 4:32 PM on June 26, 2012 [2 favorites]
Good: Unconcerned about diagnostic labels (anxiety, depression), focusing more on what is useful in helping me to understand various thoughts and behaviours and finding ways to make things more manageable. Very willing to admit that we don't understand the brain or how psychiatric drugs work. Very willing to lower my dosage far below that which is considered therapeutic for most people, and gave me lots of info about how some people are on far ends of the bell curve. (For me, a little medication goes a LOOOONG way.) Was totally cool about it when I got off my meds in an unconventional manner.
Bad: Tends to forget that I get depressed in summer, not winter, unlike the vast majority of people.
posted by heatherann at 4:50 PM on June 26, 2012
Bad: Tends to forget that I get depressed in summer, not winter, unlike the vast majority of people.
posted by heatherann at 4:50 PM on June 26, 2012
One thing that I have really appreciated from my therapist is that he has developed a network of similarly excellent doctors, which he has then shared with me. He recommended a mindblowingly good psychiatrist, and after I shared that I had a lot of anxiety about the dentist and hadn't been for several years, recommended a wonderful and gentle dentist in my area. He also let me use his name to "pull some strings" as it were; the psychiatrist was technically not accepting new patients, but since he had a working relationship with my therapist he made room for me.
Early in our time together, I told my current therapist that I'd had serious issues with past therapists oversharing and stepping right over boundary lines (wtf, I don't need to know the details of your divorce, things like that); he respected that, and while he does sometimes share personal anecdotes they are always in a professional context, and frequently checks in to make sure I'm comfortable with our boundaries.
Another thing that has been immensely helpful is that, as I start to slowly make strides toward getting better, he has made sure time and again to emphasize that it's ME who has been doing that work, not him. Even if it's something like "you have a pretty bad cold, but you still came in for your appointment today. You could have stayed home and avoided it, but you fulfilled your responsibility and didn't run away. That is great work." Sometimes therapy can feel a bit nebulous, as far as benchmarks and what you've achieved, and he does his best to make sure I DO see the progress I've made.
posted by sarahsynonymous at 4:53 PM on June 26, 2012
Early in our time together, I told my current therapist that I'd had serious issues with past therapists oversharing and stepping right over boundary lines (wtf, I don't need to know the details of your divorce, things like that); he respected that, and while he does sometimes share personal anecdotes they are always in a professional context, and frequently checks in to make sure I'm comfortable with our boundaries.
Another thing that has been immensely helpful is that, as I start to slowly make strides toward getting better, he has made sure time and again to emphasize that it's ME who has been doing that work, not him. Even if it's something like "you have a pretty bad cold, but you still came in for your appointment today. You could have stayed home and avoided it, but you fulfilled your responsibility and didn't run away. That is great work." Sometimes therapy can feel a bit nebulous, as far as benchmarks and what you've achieved, and he does his best to make sure I DO see the progress I've made.
posted by sarahsynonymous at 4:53 PM on June 26, 2012
Remember names: My worst therapists have always forgotten the names of people I talk about, and it makes me wonder if they're paying attention to anything. And I don't talk about a lot of people -- only one or two at a time during the entire course of my relationship with the therapist. I see you writing notes; write down the names.
Be professional about billing: My worst therapist quoted me her sliding scale price, then after she found out what I did for a living, lied at the next session and said she never went as low as the original price she told me. After that it was impossible to work with her -- she seemed to care more about money than about treating me, and had obviously jumped to conclusions about my salary and financial situation. If possible I would also recommend handling questions of billing in an entirely different venue, say via email/phone, or just outside the therapy room. It was really hard for me to have that conversation while sitting on her couch and then transition into having a productive conversation.
posted by telegraph at 5:04 PM on June 26, 2012 [5 favorites]
Be professional about billing: My worst therapist quoted me her sliding scale price, then after she found out what I did for a living, lied at the next session and said she never went as low as the original price she told me. After that it was impossible to work with her -- she seemed to care more about money than about treating me, and had obviously jumped to conclusions about my salary and financial situation. If possible I would also recommend handling questions of billing in an entirely different venue, say via email/phone, or just outside the therapy room. It was really hard for me to have that conversation while sitting on her couch and then transition into having a productive conversation.
posted by telegraph at 5:04 PM on June 26, 2012 [5 favorites]
Unless you have couples therapy training and extraordinarily good boundaries -- and I'd guess you don't, at this stage in your career, not good enough for this anyways -- unless you've got great boundaries, please don't see both parties in a relationship; don't try to be both parties main therapist. Yeah, of course, great to see the other party a time or two with your client and maybe -- maybe -- even on their own a time or two, to get the lay of the land. But if you try to do more than this, if you try to be both partners therapist (or, worse, both parties therapist AND run a group they are both in), then everyone involved -- yourself included -- will be totally screwed. Roles will get flattened and skewed. Everyone will get shook. Sides will get taken. There will be war. Right there, in your tastefully decorated office, there will be war.
Lynn was by far the best therapist I've ever had. But she was the best human being I've ever known, too, and that just showed up in her practice. It's called love. It can't be faked.
Okay, love, yes -- goodie goodie. What the fuck do you mean, love? And I don't even know if it can be articulated. I'll try, here.
I knew that she was with me, I knew she cared about me, I knew that her heart was in it, that she wanted the best for me. She kept showing up, and giving at the deepest level I'm aware of.
I never for a second doubted that I was being listened to -- and being heard -- in her presence. She'd ask for clarification if she didn't get what it was that was running through my mind and through my words.
I was in the deepest trouble I'd ever been in, I had no idea what manic depression could be, and in that time I found out, I fell off the edge, or ran off it, or both. Mixed states. A special kind of hell.
Lynn kept hope, when I had none, she said keep going, when I wanted to just give it up. Her love carried me. It was her love that gave me the ability to keep trying. Period. She gave that to me.
She was bright, smart, articulate, way educated, strong, artistic, interesting, she'd lived one hell of a life. All of that was important, in building my trust, my respect for her vision. But love, is what it was.
posted by dancestoblue at 5:28 PM on June 26, 2012 [2 favorites]
Lynn was by far the best therapist I've ever had. But she was the best human being I've ever known, too, and that just showed up in her practice. It's called love. It can't be faked.
Okay, love, yes -- goodie goodie. What the fuck do you mean, love? And I don't even know if it can be articulated. I'll try, here.
I knew that she was with me, I knew she cared about me, I knew that her heart was in it, that she wanted the best for me. She kept showing up, and giving at the deepest level I'm aware of.
I never for a second doubted that I was being listened to -- and being heard -- in her presence. She'd ask for clarification if she didn't get what it was that was running through my mind and through my words.
I was in the deepest trouble I'd ever been in, I had no idea what manic depression could be, and in that time I found out, I fell off the edge, or ran off it, or both. Mixed states. A special kind of hell.
Lynn kept hope, when I had none, she said keep going, when I wanted to just give it up. Her love carried me. It was her love that gave me the ability to keep trying. Period. She gave that to me.
She was bright, smart, articulate, way educated, strong, artistic, interesting, she'd lived one hell of a life. All of that was important, in building my trust, my respect for her vision. But love, is what it was.
posted by dancestoblue at 5:28 PM on June 26, 2012 [2 favorites]
I just wanted to reiterate what other posters have said about their therapist remembering details about them. Whether it's because this is her personal style or a practice required by her employers, I don't really know, but my therapist has taken extensive notes on all the things I've brought to her since I started seeing her 6 years ago, and as such, she knows my personal history so well that I would be loathe to start seeing anyone new. She also took a long time before she started self-revealing personal details that were relevant to our discussions, though she's maintained a professional no-emails boundary that I've decided I really appreciate, and she has been incredibly willing to drop topics we've been working on for weeks to address new things that crop up when they do. She's just made a point to let me know that I am legitimately important to her and shows me every time I see her. (Obviously this is something that can't always be implemented; what if you end up finding one of your clients super irritating?) I'm grateful that she treats me reasonably and respectfully and from there, all other good follows.
posted by Hello Darling at 6:33 PM on June 26, 2012 [2 favorites]
posted by Hello Darling at 6:33 PM on June 26, 2012 [2 favorites]
My therapist always rebuts negative self-talk. Not in a fighty way, just a gentle "But don't you think that in a way, maybe instead it's just that..." etc. It's great to have someone defend me when I pick on myself.
posted by threeants at 7:06 PM on June 26, 2012
posted by threeants at 7:06 PM on June 26, 2012
Also, I am aware through Googling that my therapist is a very active member in a religious community that I don't share, but I never would have known otherwise-- he never brings it up in a way that would make me uncomfortable.
posted by threeants at 7:19 PM on June 26, 2012 [3 favorites]
posted by threeants at 7:19 PM on June 26, 2012 [3 favorites]
I am a therapist, and I've seen a handful of therapists. I LOVE the one I see now, because he acts like a human, and treats me with the acknowledgement that I'm a human too. Therapists are NOT superhuman and it generally bothers me a lot when therapists try to maintain a cold distance from clients, rather than trying to connect with them first as humans, and second as a professional treatment provider. He laughs when I make jokes, remembers my history pretty well, and is just very present in sessions. He is himself and it lets me be myself. This is, I think, the greatest gift a therapist can give. :)
posted by so_gracefully at 7:21 PM on June 26, 2012
posted by so_gracefully at 7:21 PM on June 26, 2012
Knowing that the session starts from the moment you two meet...their demeanor from the get-go is important to the client. If the therapist seems rushed, flustered, absent-minded, etc...this will have an impact on the session. If you need to be five minutes late to focus and be ready for your client, take that time.
Owning up to when you've lost your focus. "I'm sorry, I lost you for a moment, please repeat what you just said." Because everything the client says is important...they are bringing in just a sliver of their lives, and what they choose to tell you is vital. We are humans and our minds may wander at times, and it is ok. If your client gets upset about it, that is a talking point worth discussing.
Be challenging when the time is right. I hear from so many people that they feel like they go and just talk for an hour without getting much back. This might be the case during the information-gathering phase, but don't be afraid to challenge your client...this is why they are there.
Turn off your phone, or if you must have it on, put it on vibrate. Then the interruption will be at least not as jarring.
Be enthusiastic when your client is making a breakthrough. I think some therapists make the mistake of being robotic/monotone, which does serve its purpose. But when your client latches on, gets it, etc...let them know they have made great gains and celebrate it. I remember when my therapist stopped me in the middle of a story where I stood up to my ex, and pointed out just how important it was, it made me feel great and I built on that feeling!
On the other hand...bad therapists: try to solve you problems for you and too soon. Pushing books and resources (unless it is a crisis) in the first session can make people feel like their issue are being trivialized and that they aren't really being listened to.
Great question, and good luck!
posted by retrofitted at 7:22 PM on June 26, 2012 [3 favorites]
Owning up to when you've lost your focus. "I'm sorry, I lost you for a moment, please repeat what you just said." Because everything the client says is important...they are bringing in just a sliver of their lives, and what they choose to tell you is vital. We are humans and our minds may wander at times, and it is ok. If your client gets upset about it, that is a talking point worth discussing.
Be challenging when the time is right. I hear from so many people that they feel like they go and just talk for an hour without getting much back. This might be the case during the information-gathering phase, but don't be afraid to challenge your client...this is why they are there.
Turn off your phone, or if you must have it on, put it on vibrate. Then the interruption will be at least not as jarring.
Be enthusiastic when your client is making a breakthrough. I think some therapists make the mistake of being robotic/monotone, which does serve its purpose. But when your client latches on, gets it, etc...let them know they have made great gains and celebrate it. I remember when my therapist stopped me in the middle of a story where I stood up to my ex, and pointed out just how important it was, it made me feel great and I built on that feeling!
On the other hand...bad therapists: try to solve you problems for you and too soon. Pushing books and resources (unless it is a crisis) in the first session can make people feel like their issue are being trivialized and that they aren't really being listened to.
Great question, and good luck!
posted by retrofitted at 7:22 PM on June 26, 2012 [3 favorites]
Mine has a discreet little clock on the side table next to me and the one next to him. I can't tell you how much I appreciate that he doesn't have to visibly turn his attention away from me to check the time... and that I, too, can freely track where we are in the session.
I know very, very little about his life or experiences, which works very well for me, but I understand there's a wide variety of opinion about that. That said, he does laugh when I do, and register surprise when I say something unexpected, etc., so he's certainly not in the cold/robotic mode either.
It's also immensely helpful that he is never, ever judgmental if I've cancelled or missed a session. Honestly, I don't think he mentions it at all, and I find that very conducive to my comfort and ability to keep at it.
(I also really like it that I can put my feet up on his couch or coffee table, but maybe that doesn't come up all that often. Sunlight and natural air are key for me, too. Oh, and don't skimp on the quality or quantity of the tissues! And make sure there's a trash can within easy reach.)
Best of luck.
posted by argonauta at 7:59 PM on June 26, 2012
I know very, very little about his life or experiences, which works very well for me, but I understand there's a wide variety of opinion about that. That said, he does laugh when I do, and register surprise when I say something unexpected, etc., so he's certainly not in the cold/robotic mode either.
It's also immensely helpful that he is never, ever judgmental if I've cancelled or missed a session. Honestly, I don't think he mentions it at all, and I find that very conducive to my comfort and ability to keep at it.
(I also really like it that I can put my feet up on his couch or coffee table, but maybe that doesn't come up all that often. Sunlight and natural air are key for me, too. Oh, and don't skimp on the quality or quantity of the tissues! And make sure there's a trash can within easy reach.)
Best of luck.
posted by argonauta at 7:59 PM on June 26, 2012
My current therapist is awesome for many reasons: one (also mentioned above) is that he's all substance and no style, which I find very endearing.
Another thing I really appreciate is that if he senses hesitance or a pause after he asks a question, he'll let me know why he's asking or why he thinks it's important, but never in a technical "I am quoting this from a textbook" kind of way.
He has about a billion old issues of The New Yorker in his waiting room.
Ditto the 'taking care of money elsewhere' issue. Can't stress this enough. Making money an issue is a fast way to lose trust, which is a loss of authority and eventual loss of the patient.
I can't comment on the gestures because I lay on an old-school Freudian couch, which I love dearly and wish I'd done before, or been given the opportunity to do before without having it seem like the weird, old school alternative that some people used to do.
He starts the sessions out thusly: "last time, we were talking about such-and-such, and I was reviewing your notes, and that got me thinking about [INSERT INSIGHT HERE]. Maybe we could start there: tell me about..." So right from the start, he's letting me know that our session isn't just about the hour, but the time he spends afterwards, analyzing it. I've been to a few therapists, and this is the first time it's ever dawned on me that they must read those notes. Others have just started sessions by regurgitating, but no one has ever done such an awesome job of doing their homework, so to speak, which really helps me open up.
posted by blazingunicorn at 9:56 PM on June 26, 2012 [5 favorites]
Another thing I really appreciate is that if he senses hesitance or a pause after he asks a question, he'll let me know why he's asking or why he thinks it's important, but never in a technical "I am quoting this from a textbook" kind of way.
He has about a billion old issues of The New Yorker in his waiting room.
Ditto the 'taking care of money elsewhere' issue. Can't stress this enough. Making money an issue is a fast way to lose trust, which is a loss of authority and eventual loss of the patient.
I can't comment on the gestures because I lay on an old-school Freudian couch, which I love dearly and wish I'd done before, or been given the opportunity to do before without having it seem like the weird, old school alternative that some people used to do.
He starts the sessions out thusly: "last time, we were talking about such-and-such, and I was reviewing your notes, and that got me thinking about [INSERT INSIGHT HERE]. Maybe we could start there: tell me about..." So right from the start, he's letting me know that our session isn't just about the hour, but the time he spends afterwards, analyzing it. I've been to a few therapists, and this is the first time it's ever dawned on me that they must read those notes. Others have just started sessions by regurgitating, but no one has ever done such an awesome job of doing their homework, so to speak, which really helps me open up.
posted by blazingunicorn at 9:56 PM on June 26, 2012 [5 favorites]
Here are some of the things my favorite therapists have done:
- Was surprised to hear of another therapist's breach, and I think she did something about it (as one of the heads of the practice) -- the trait I'd pass on to you is that she came across as completely ethical and trustworthy; the fact that I don't know what happened with the other therapist is another point for her in my book, since I want to feel that things are very separate and delineated
- Let me decide how to talk and approach things and matched that, e.g. if I was informal, were a bit more informal at me
- Thought the best of me
- Had engaged, but slightly detached physical posture (would clearly sit at attention, but wouldn't be hanging on my every word)
- Took notes unobtrusively
- Respected what I had to say (e.g. what bothered me, what I wanted to do, listening when I talked)
- Gave concrete answers and tools to deal with problems
I'm putting these in opposition to therapists who didn't do a great job for me, personally; there was one who told me to set down the glue during play therapy because she thought I was sniffing it--NOT thinking the best of me--and another who mostly addressed my mother during a joint session. I don't know whether you'll work with families, couples or individuals, but one thing I greatly appreciated as an adolescent in therapy was being treated as a full member of the therapy session.
posted by ramenopres at 9:56 PM on June 26, 2012
- Was surprised to hear of another therapist's breach, and I think she did something about it (as one of the heads of the practice) -- the trait I'd pass on to you is that she came across as completely ethical and trustworthy; the fact that I don't know what happened with the other therapist is another point for her in my book, since I want to feel that things are very separate and delineated
- Let me decide how to talk and approach things and matched that, e.g. if I was informal, were a bit more informal at me
- Thought the best of me
- Had engaged, but slightly detached physical posture (would clearly sit at attention, but wouldn't be hanging on my every word)
- Took notes unobtrusively
- Respected what I had to say (e.g. what bothered me, what I wanted to do, listening when I talked)
- Gave concrete answers and tools to deal with problems
I'm putting these in opposition to therapists who didn't do a great job for me, personally; there was one who told me to set down the glue during play therapy because she thought I was sniffing it--NOT thinking the best of me--and another who mostly addressed my mother during a joint session. I don't know whether you'll work with families, couples or individuals, but one thing I greatly appreciated as an adolescent in therapy was being treated as a full member of the therapy session.
posted by ramenopres at 9:56 PM on June 26, 2012
(fwiw, I had no idea what the glue therapist was talking about; it made me feel confused before I felt wrongly accused, and neither of those is good to walk away with!)
posted by ramenopres at 10:01 PM on June 26, 2012
posted by ramenopres at 10:01 PM on June 26, 2012
I was talking with my therapist about how I could remember even as a kid having anxiety issues. My family was homeless, my mom was in a seriously abusive relationship, and it had a huge impact on my performance at school, in life, etc.
My therapist said, "You know what? If I were in that situation, I would have felt the exact same way."
It may not seem like much, but, it was the first time a person had said something other than "wow you're fucked up" and, instead, made me feel normal about an issue that is really difficult for me to talk about.
That 20-30 second conversation impacted me deeply, in a good way.
posted by blahtsk at 11:34 PM on June 26, 2012
My therapist said, "You know what? If I were in that situation, I would have felt the exact same way."
It may not seem like much, but, it was the first time a person had said something other than "wow you're fucked up" and, instead, made me feel normal about an issue that is really difficult for me to talk about.
That 20-30 second conversation impacted me deeply, in a good way.
posted by blahtsk at 11:34 PM on June 26, 2012
My best therapist shared my sense of humor. I've had a couple of nice, good, earnest ladies as therapists, but the one that I really hit it off with was someone who could be utterly sympathetic AND also laugh. If something was fucked up, but also slightly hilarious, she didn't ignore the funny side. She also was an extraordinarily insightful woman with a gift for coming up with great ways to reframe things, but the thing that mattered the most to me was definitely that I felt like I could be myself with her.
posted by MsMolly at 8:30 AM on June 27, 2012 [2 favorites]
posted by MsMolly at 8:30 AM on June 27, 2012 [2 favorites]
One thing that always really bothered me about therapy was handing a check directly to the therapist. It really kinda violated some of the sanctity for me because there was this reminder that the therapist needed to be paid. I mean, of course they do! It wasn't the paying -- it was the directly handing over to the therapist part --- particularly after a bad time, it was really awkward.
So, while you may not be able to afford an assistant, having some type of locked box on the door for payments or a mail-in-option or some other way of being able to leave payment for you would have been extremely helpful me.
This may be less of an issue if you work in a group practice that does have an assistant.
posted by zizzle at 10:18 AM on June 27, 2012
So, while you may not be able to afford an assistant, having some type of locked box on the door for payments or a mail-in-option or some other way of being able to leave payment for you would have been extremely helpful me.
This may be less of an issue if you work in a group practice that does have an assistant.
posted by zizzle at 10:18 AM on June 27, 2012
I was with my last therapist for five years; we just stopped seeing each other a few months ago. Things that made her awesome:
- She was very good at being very friendly without overstepping any bounds. She would compliment me on a new purse or a dress when I came into an appointment, which always made me feel good about myself and more open to talking to her.
- She wasn't afraid to swear or let me swear. As someone with the mouth of a sailor, this made me feel good.
- Echoing someone upthread who said sharing personal info, but not too much. I didn't find out until a few years in that she was in a long-term relationship, but I was glad when she shared that with me.
- She had an excellent memory for small details. She seemed to remember all of my friends' names, specific incidents I had told her about years before, etc. It made me feel like she really was listening and cared.
- Just seemed very genuine about her concern for me. She would gently talk me out of my very hard-headed ways and never tried to force me into anything I didn't want to do.
- Was always open via e-mail or even text message.
My sister is studying to be a therapist, as well, so I might send this thread on to her.
posted by anotheraccount at 11:18 AM on June 27, 2012 [1 favorite]
- She was very good at being very friendly without overstepping any bounds. She would compliment me on a new purse or a dress when I came into an appointment, which always made me feel good about myself and more open to talking to her.
- She wasn't afraid to swear or let me swear. As someone with the mouth of a sailor, this made me feel good.
- Echoing someone upthread who said sharing personal info, but not too much. I didn't find out until a few years in that she was in a long-term relationship, but I was glad when she shared that with me.
- She had an excellent memory for small details. She seemed to remember all of my friends' names, specific incidents I had told her about years before, etc. It made me feel like she really was listening and cared.
- Just seemed very genuine about her concern for me. She would gently talk me out of my very hard-headed ways and never tried to force me into anything I didn't want to do.
- Was always open via e-mail or even text message.
My sister is studying to be a therapist, as well, so I might send this thread on to her.
posted by anotheraccount at 11:18 AM on June 27, 2012 [1 favorite]
Quadrupling the "don't make them hand you money" part. It creates a weird dynamic. With most of my therapists, I either had to pay them the money or co-pay before or after the session, which means the first or last five minutes were devoted to this, including writing out receipts.
With my latest therapist, he just asked for my credit card number in the intake forms, and charged it accordingly. It was amazing to me how much that changed my relationship to a therapist. When I had to sit there and write out a check, or put together a wad of cash, it set up a dynamic of "I am employer, you are employee" that was impossible for me to set aside. With the latest therapist, I didn't have to think about him like that, and I was able to get much, much more out of it.
All of that said, I'm realizing he's also the first therapist I've had (again, of many) who didn't sit between me and the door. Interesting.
posted by kinsey at 5:55 PM on June 27, 2012
With my latest therapist, he just asked for my credit card number in the intake forms, and charged it accordingly. It was amazing to me how much that changed my relationship to a therapist. When I had to sit there and write out a check, or put together a wad of cash, it set up a dynamic of "I am employer, you are employee" that was impossible for me to set aside. With the latest therapist, I didn't have to think about him like that, and I was able to get much, much more out of it.
All of that said, I'm realizing he's also the first therapist I've had (again, of many) who didn't sit between me and the door. Interesting.
posted by kinsey at 5:55 PM on June 27, 2012
it set up a dynamic of "I am employer, you are employee"
I also don't like to deal with money in the session but have always done so. The employer/employee was a good thing in that it reminded me that I'm in charge of my own "recovery" and that if the therapist was suggesting things that absolutely didn't work for me, I could say no, and that I could quit if I wanted. Sounds dumb, no? And yet so much of my work is remembering that I have agency (sorry for the therapy speak) over my own life and decisions.
That reminds me- I grew up in the 1980s PLUS my parents are counselors PLUS I've ended up with way too many therapists and counselors in my circle, so anything that strikes me as therapy-speak had better be couched in either an apology or "ironically." As an example, there is no way for me to take seriously any sentence that starts with "so what I hear you saying is". The new one that makes me laugh (but doesn't make me cringe) is "tell me/talk more about that."
posted by small_ruminant at 7:04 PM on June 27, 2012
I also don't like to deal with money in the session but have always done so. The employer/employee was a good thing in that it reminded me that I'm in charge of my own "recovery" and that if the therapist was suggesting things that absolutely didn't work for me, I could say no, and that I could quit if I wanted. Sounds dumb, no? And yet so much of my work is remembering that I have agency (sorry for the therapy speak) over my own life and decisions.
That reminds me- I grew up in the 1980s PLUS my parents are counselors PLUS I've ended up with way too many therapists and counselors in my circle, so anything that strikes me as therapy-speak had better be couched in either an apology or "ironically." As an example, there is no way for me to take seriously any sentence that starts with "so what I hear you saying is". The new one that makes me laugh (but doesn't make me cringe) is "tell me/talk more about that."
posted by small_ruminant at 7:04 PM on June 27, 2012
Not leaving you hanging at the end of the session. If someone is having a hard session don't leave them in that place at the end. Help them create something to take with them to empower them through to the next session.
I have read posts here about what to do after a therapy session to 'recover'. That recovery should be happening right there, in the session, as far as I am concerned. Have them leave feeling empowered and in a positive space. Even if it is just taking a few minutes in the end to create that.
posted by Vaike at 8:33 AM on June 28, 2012 [2 favorites]
I have read posts here about what to do after a therapy session to 'recover'. That recovery should be happening right there, in the session, as far as I am concerned. Have them leave feeling empowered and in a positive space. Even if it is just taking a few minutes in the end to create that.
posted by Vaike at 8:33 AM on June 28, 2012 [2 favorites]
My therapist ended every session with "Remember to have fun," as he ushered me out of his office. That message was incredibly important to hear.
posted by roger ackroyd at 12:17 PM on June 28, 2012
posted by roger ackroyd at 12:17 PM on June 28, 2012
Response by poster: Wow, everyone, thank you for sharing these heartfelt insights. I've appreciated every single one, and have been surprised by more than a few. Thanks!
posted by namesarehard at 1:33 PM on June 28, 2012
posted by namesarehard at 1:33 PM on June 28, 2012
My therapist texts me to schedule and remind me of appointments, which is my favorite method of communication, particularly with her - it's unobtrusive and easy, much better than dealing with phone calls at work. Twice in three years I've requested an emergency session, and she was very responsive. She also checked in with me - just a quick 'wanted to see how you are doing' text - when I was having a particularly hard time, which meant a lot.
Also, I had a change in insurance and my therapist was willing to talk about it and consider going on to my plan - ultimately she didn't, but she did the research of talking to other therapists and explaining to me her reasons, which I appreciated.
During a couple of hard moments, she asked if she could give me a hug, which I really wanted and valued. Not for everyone, but very meaningful for me, and I appreciated her asking first.
posted by theflash at 5:18 PM on July 6, 2012
Also, I had a change in insurance and my therapist was willing to talk about it and consider going on to my plan - ultimately she didn't, but she did the research of talking to other therapists and explaining to me her reasons, which I appreciated.
During a couple of hard moments, she asked if she could give me a hug, which I really wanted and valued. Not for everyone, but very meaningful for me, and I appreciated her asking first.
posted by theflash at 5:18 PM on July 6, 2012
This thread is closed to new comments.
posted by namesarehard at 3:09 PM on June 26, 2012