My golden rule of therapy

I grew up in a family where psychotherapy was the norm. Both my parents where psychologists and psychotherapists. My father was actually a bit of a trail blazer as well and was very much a psychotherapy type of psychologist. Originally psychoanalytic and Rogerian in his approach. In the state where we lived he was one of the first to go out into the world to learn the new psychotherapies being practiced and bring them back to where he worked. Very few, if any other psychologists would do such a thing. 

He was the first psychologist to go into private practice in the city where we lived. And besides what was then called the “Marriage guidance council” (which later became know as Relationships Australia) he started the first private psychotherapy training institute in the state. The Marriage guidance Council was a government funded body which people could go to to get marriage counselling and he was heavily involved in the training of counsellors for that organization.

Here is a photograph of my father at a workshop in Australia with Carl Rogers in 1965. He is in the back row third from right. As you can see he got the other participants to sign it including Carl. Also notice the ratio of men to women. Nowadays it would be the other way around.

The point at hand is I grew up with this and psychotherapy was nothing odd for me like it was for many people. I recall when I was about 17 (still at school) I got into some trouble and my parents suggested I might try a therapy group. So I went along and it was run by two female cotherapists and there were about 6 clients, all young people so it was probably a therapy group for that age group. I recall finding it quite helpful. I never rebelled against therapy or going to a therapists like some teenagers or children can do. 

I then started training as a psychotherapist at about age 22. As many therapists did then (and do now) I did some personal therapy in groups and individual therapy. There was probably a period of about 5 to 10 years when I did a fair bit and I am glad I did. I think I am much less of an uptight and tense person as a result of it. Less of an obsessive thinker and this also has helped me in life.

An uptight obsessive thinker?

There was this period where I did concentrate on my own personal work and then after that I felt less of a need to and that is when I made a golden rule for myself. I never asked anyone about this or even talked to anyone about it but I decided that I would always have a therapist of some kind. There were two reasons for this.

First it is always good to have an outside person who you can reflect with and get their feedback about your thinking and feeling about things at the time. It kind of helps to keep you grounded and realistic. Second, as I was a psychotherapist I discovered it was very easy to forget what it was like for the client. If one is always in the therapists chair one can forget what it is like for the client. I found it was most helpful to be reminded from time to time what it is like sitting in the client’s chair. I found it certainly did help me as a therapist to do this, at least intermittently.

In more recent times this has been done on more of an informal basis as compared to when I was in my 20s. I have a colleague whom I meet with from time to time and every now and then we do a bit of therapy on each other and this satisfies my need for the two reasons I listed above. Interestingly if I look back at my history of personal therapy I notice a pattern. Three therapists stand out in particular, who I think have had the most impact on me and they are all strong willed women. Just an interesting observation.

But in retrospect I am glad that I spontaneously made my golden rule of therapy for myself. I think it has served me well over the years. Maybe because I grew up in a family where psychotherapy was the norm rather than the abnormal, that helped in making this spontaneous decision.

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Empathy

My blogger friend Linda asks about empathy. I wrote this some time ago for a workshop.

Empathy is quite a complicated psychological process when one gets down to describing it theoretically. I suppose this is to be expected as it is considered one of the more ‘higher’ forms of communication compared to the more basic and primitive processes such as simply communicating feelings to another.

Carl Rogers states that empathy is not just the cognitive understanding of the client‘s experience, but actually experiencing it without getting lost in it.


He says to sense the client’s confusion, timidity or anger as if it were the therapist’s own but without getting lost in it. That is without it becoming to big in the therapist or negatively impacting on their ability to function. The therapist can then communicate that understanding to the client.

Reference
(Rogers(1962), The interpersonal relationship: The core of guidance. In Rogers and Stevens (eds.) “Person to Person”).

These are some examples I found in the text books of empathy being expressed

“It must be very frightening to be so uncertain about your job security.”

“I think I see what you are saying. In some ways you like coming here and talking to me, but you’re not sure it’s really doing very much for you.”

“My goodness, you really love her, don’t you?”

This process described however rests on magical thinking and thus is a flawed process or at least a flawed description of the process.



Lets examine the process of empathy from an ego states perspective.

1. Therapist is aware and comprehends their observations of the client.

The Adult ego state of the therapist observers the clients behaviour and verbal reports of what they are experiencing.

2. Therapist has their feeling reactions to the awareness and comprehension of the client.

3. Therapist’s Parent ego state keeps the Free Child reaction in check such that it does not get too large or debilitating to the therapist and that the gaol remains the welfare of the client rather than the therapists own Free Child needs.
4. NP caring combines with FC feeling reactions and Adult ego state understanding to have an empathetic response to the client. As you can see quite a complex psychological process.



It should be noted that one can not experience what the client is experiencing, one can only have a feeling reaction to it. This feeling allows the therapist’s experience to be what he perceives is a copy of the client’s experience but this is only ever a guess as one cannot experience what another person is experiencing.

Ironically in this way empathy is quite self centred and narcissistic process. It is about me and my understanding of the experience of the client. It becomes about the other in the last stage of the process with the NP involvement. The therapist’s personal experience of the client is then used in a caring way to the benefit of the client.

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Introjection in the therapy process

On July 30th, 2010 I wrote a post about Carl Rogers and his therapy. He proposed that a therapist needs to display 3 qualities when working with a client. These are:

Genuiness - Therapist is aware of his own feelings, thoughts and attitudes and these are not concealed from the client.

Empathy - Understanding the client’s experience from the client’s point of view.

Unconditional positive regard - Conveying to the client that they are worthwhile humans no matter what they do.



If these happen then over time this positive relationship is seen to bring alive the person’s natural desire to grow towards health. The Free Child aspect of the personality ‘sparks’ up and the person naturally grows towards psychological health. A reasonable hypothesis that has been widely accepted by the therapeutic community one could say.

However there is another aspect to this. Another feature of the therapeutic process and that is the mechanism of introjection. Any two people who form any sort of relationship then introjection will occur between them. It will happen unconsciously and relentlessly. It will happen to everyone but the extent and rate of introjection can vary between people and circumstances.

The therapeutic environment is a prime breeding ground for introjection of the therapist by the client. It is well designed for this to happen at least in some ways.

Introjection can be explained theoretically as the incorporation of the therapist into the client’s Parent ego state. Over time the client will incorporate the therapist’s personality into their own via this mechanism. The therapist’s personality becomes part of the client’s personality. It will happen back the other way but to a lesser degree.



I recall a number of years ago I used to run a respite programme for an organisation called ARAFMI (Association for Relatives and Friends of the Mentally Ill.) We took away on a holiday 7 people with chronic mental illness so their carers at home (usually their parents) could have one week respite from caring for them. So myself and an assistant lived in close contact with 7 people for a week who usually were diagnosed with either chronic schizophrenia, bipolar or psychotic depression. I tell you what, it was one of the best learning experiences I ever had about these types of mental illness. I learnt more about how they think, feel and function that I ever could with a 5 year degree.

However my point is I lived in close contact with a group who were heavily medicated, had been for a long time and were probably going to be for a long time. Because of the medication many were quite over weight or obese and they generally had this slow moving sort of swaying way of walking. By the end of the week I would be walking like them! Without even knowing it I began to walk like them. The introjection process on display.

In the counselling setting introjection will occur more, the longer the client has been seeing the therapist, the more frequent the client sees the therapist and the stronger the transference the client has for the therapist. The more these three conditions are met the more the client will introject the therapist as part of their personality.


Will these children wear helmets when they ride a bike in the future?

If the therapist is being genuine, empathetic and giving positive unconditional regard then the client will introject that. If the client starts to take this in as part of their own personality then they are going to treat their own Child ego state in these ways as well. If that happens then the person will start to feel better about self and thus grow in a more psychologically healthy way. Another explanation why the Rogers therapeutic approach may be successful.

However unfortunately it works both ways. If a therapist uses painful therapeutic techniques then that attitude or ‘permission’ will be introjected as well. Many therapeutic techniques are painful to some degree and involve the client regressing and experiencing painful emotions and confronting old painful memories. If the therapist allows this to happen and indeed promotes it as most do then the client will introject that into their Parent ego state as shown in the diagram. I use such techniques at times and thus one needs to be cautious of such therapeutic techniques and the introjection that occurs.



Then there are the pharmacotherapies like methadone for heroin addiction. There is an inherent contradiction in these approaches. The therapist says “Take these drugs, so you don’t take drugs”. The permission to take drugs is introjected by the client by the very actions of the therapist. Again, I am not anti methadone and have seen it be useful for some opiate users. However in any over all treatment plan one must be at least aware of this contradiction and introjection occurring in the client.

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Carl Rogers and health

Harriet states: I also thought of Carl Rogers when I read this. What did he say? Something like every person's goal should be to be the person who they truly are.

Carl said a lot of things Harriet. In his original writing there is a lot on transference that includes taped dialogue from sessions he did with clients. They are very interesting to read as one gets a bit of insight into how he worked as a therapist. However most of this is forgotten and he is most widely known for his clarification of the three essential features of the therapist in relationship with the client.

Genuiness - Therapist is aware of his own feelings, thoughts and attitudes and these are not concealed from the client.

Empathy - Understanding the client’s experience from the client’s point of view.

Unconditional positive regard - Conveying to the client that they are worthwhile humans no matter what they do.

Home wrecker

This has had a profound effect on the practice of psychotherapy which is why he is regarded as one of the greats of the field. As usual it is the simplicity that makes for it being more profound.

It seems reasonable to conclude that he was not the first to think this up. People would have known long before Rogers time that being genuine and empathetic was good for a relationship especially a helping relationship and I am sure teachers long before Rogers would have told their students such a thing. However he articulated it well and was in the right place at the right time and thus he became known as he is.

However this does raise an interesting and debated point of view. His approach and philosophy rests on the assumption that, “Love will cure it”. That is if you place a person into an environment or relationship that is genuine, empathetic and has unconditional positive regard they will naturally get better.

If you place a person in a nurturing and positive environment then their natural urge to grow and develop will be activated and the person will grow and develop towards psychological health. In transactional analysis terms it would be said that the Free Child aspect of the personality is energised or cathected and this is where the desire to grow towards health results from.

There is another school of thought that says, “Love alone is not enough for cure”. Without a doubt a loving, positive environment is good for one’s psychological health, but there is also an Adapted Child part of the personality that propels the person to ill health (or to their life script).

This side of the debate say that pure positivity is not enough to counter the drive to psychological ill health. At some point in the treatment you have to deal with this and that means doing something with the client that is experienced as painful in some way. That may be a confrontation of some kind that the client does not want to hear, getting the client to face their mother or father who abused them and so forth.

Some form of painful treatment is applied and this raises much heated debate. There are a group who say a client should never be subjected to painful treatment techniques with a common example being ECT or some form of aversion therapy like happened in the movie Clockwork Orange. You could argue that Carl Rogers would have been of the view that you do not apply painful treatments.

Carl Rogers workshop (1965)

My father back row third from right

Carl Rogers front and centre.

Of course there are much less dramatic painful techniques than ECT or aversion therapy and I certainly use some of them myself. For instance some two chair techniques could be placed in this category and this fits with my personal philosophy. Unconditional positive regard, empathy and genuiness as most useful in allowing the client to grow towards health but they are not enough in most instances. The AC is an active part of the personality that ‘love’ alone cannot over ride. It needs at some point to be dealt with directly and that usually involves some kind of angst for the client. Keep it to a minimum for sure but it is needed at times.

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