Contents
What should be a good psychotherapist? We are being asked this question more and more often. In search of an answer, we turned to the books of Irvin D. Yalom (Irvin D. Yalom) and imagined a letter that he could write to aspiring colleagues. And then they asked Psychologies experts to supplement it.
Dear colleague, dear friend, you are just starting your career. And this is my forty-sixth year of practice, and my patients dream of cobwebs on my hat left in the office. Time runs. Time does not wait. Therefore, I would like to share my knowledge, and as soon as possible. Even if all I can advise you is to “mature at your own pace, seriously, calmly”, without waiting outside for “answers that can only be born from your innermost feeling, in an hour of deep concentration”, as Rilke wrote in “ Letters to a young poet”, which I love so much.
Try to refuse diagnoses and drug treatment — these obsessions that distort our profession today. The developments of pharmacists will not give an answer to the main questions of life that worry those who come to us for advice. We will not find these important questions in textbooks of psychiatry among diagrams and tables, intricate as the menu in a Chinese restaurant. Our job is to help the patient gradually open up: to us, but above all to himself. Diagnosis narrows the field of view and makes it difficult to see a person. In trying to find a universal approach that suits everyone, we lose sight of creativity and individuality, we forget that psychotherapy is not only a treatment, but also an adventure.
- The first consultation of a psychotherapist: what to expect from her?
Remember the secret of success is not so much in solving the mysteries of life, but in creating a strong relationship with the one who sits in the chair in front of us. This relationship will become a real healing tool. Yes exactly! I am convinced that relationships with other people affect a person no less than his own internal impulses discovered by Freud. Establish contact — and you will see how the patient discovers his difficulties, anxieties, suppressing his inhibitions and unrealized inner potential. Do not attach too much importance to the patient’s past: «here and now» are no less important in a trusting relationship. In any case, he will replay in relations with you what once affected him. In these relationships, everything will definitely come up: both current problems and deeply hidden traumas …
Do not lose sight of the goal: the elimination of symptoms, the relief of the patient’s suffering, on the one hand, and his personal development, significant changes in character, in his view of himself and the environment, on the other. For the sake of this goal, keep the limits, stick to the rules that you set in working with him, but do not get hung up on theory. Say «no» to formalities! Each life is unique, and therapy requires a special approach to each patient. Many have written that overconfidence should be avoided during therapy. However, I know from experience that when the therapist openly answers personal questions that the patient wants to ask him, this allows significant progress in therapy. Remember the ethics of our profession: never have an intimate relationship with a patient. For the rest, don’t give up. Observe how the patient behaves when entering the office, what remarks he makes about the setting, or your appearance, or the fee. Answer him: tell him how you feel about his remarks and what he does, give him an idea of what kind of reactions he evokes with his words and actions. What for? The point is this: in this way you will show the patient an image of himself that is different from the one that he has developed (or has not developed); you will help him carefully look behind the mirror against which he has long been resting.
- Psychotherapy: The Day I Realized It Works!
Listen to the patient’s dreams: take what you can from them, collect them. This is an invaluable source for the study of creativity, fantasy, human poetry. Set the accents: at the end of the session, ask the patient what he experienced, what happened over the elapsed time, in his opinion.
Work! It is very useful to take notes during the session — topics of conversation, impressions, moments of doubt — and reread them on the eve of the next meeting. Pause between patients to prepare for the upcoming appointment. I would recommend at least a 10 minute break. You are not a robot. Do not shackle yourself, do not give in to the temptation to earn more, do not scatter. Empathy is your calling, you have no right to treat it casually. Don’t exhaust your strength. Don’t drive yourself to exhaustion. Regularly take a course of psychotherapy to restore your inner resources, and do not forget about food for the mind and soul, dear colleague. Painting, sculpture, music, philosophy, poetry… All means are good, especially those that expand your horizon, increase knowledge, open before you the depths of the human psyche, in which innumerable possibilities of healing are hidden. Because we are the keepers of secrets. And secrets can hurt.
Yours sincerely.
Vadim Petrovsky, psychologist-consultant: «Communicate on an equal footing»
There are, I think, four layers of counseling. The first I call “creative partnership”. This is a joint answer to the question «What to do (today, tomorrow)?». Already after the first meeting, the client will feel that things are going well. The second is the formation of a «general thesaurus», «information for thought». You know something beyond what a smart fellow traveler from the top shelf in a long-distance train knows. Facts and knowledge must work; they are non-trivial, informative, existentially significant. The third one is “modeling of situations” and “new dramaturgy of communication”. Sometimes it is important to return to situations where destructive scenarios of behavior developed and re-solve outdated solutions. The fourth is the «I-Thou» communication. Do not talk about yourself in the form of a parable. Tell exactly about yourself. Of course, no one knows what “I am You” means… But… Meditate on these words: “I am You”! Maybe you will feel something … Advice for beginners: do not be nervous during the session! If it seemed to you that nothing helped, and your client thinks the same way, refuse material rewards.
Lyudmila Petranovskaya, developmental psychologist: «Avoid the role of the Rescuer»
It is important for domestic psychologists and people in helping professions to take into account: in our collective unconscious, the roles of the Rescuer and the Aggressor are close. At the word “care” in groups, many take their hands by the throat, as if something is choking them. Our systems of help and support have long been systems of violence, with concentration camp customs, humiliating rules — remember even a maternity hospital, even a hospital, even a pioneer camp. From everyone who is associated with help — and therefore with our helplessness and dependence — we expect violence. Anyone who helps is dangerous. And if this is his profession, he is doubly dangerous, because he «knows the tricks.» Hence the hostility towards psychologists that one has to face. On the other hand, helpers themselves often fall into this trap, starting to “do good” to everyone who did not have time to escape. It is important to keep track of this. Ask yourself: who am I running to save now? was I asked? if asked, what exactly? Contractual relations are difficult to come by in our land of paternalism and erased borders. This requires professional vigilance and responsibility.
Victor Kagan, psychotherapist, MD: «Listen and hear»
If you are not interested in yourself, don’t sit in the therapist’s chair. The patient is not a carrier of symptoms, but a bunch of experiences. The reality of therapy is experiences, they perish in the cold of rationality. The art of therapy cannot be mastered, but it must be mastered. The path to the art of therapy lies through the craft. The craft is not a set of techniques, but the ability to use them freely and creatively. The main tool of therapy is the ability to listen and hear what the patient is really saying. Let the patient listen and hear himself. Do not look at the patient through glasses of morality and do not teach him how to live. Walk with the patient, don’t walk instead of him, don’t be Pushing. Mystery, uncertainty — the air of therapy. Don’t know what to do? Make silence and listen to it. Respect the patient’s right to pain and suffering — they are the fire of life: help the patient to support him so that he does not become a fire. The main mistake is the lessons not taken from the mistake. You are 100% responsible for success and the patient is 100% responsible: do not shift your responsibility to him — Bolivar cannot bear two. You are not paid for time, but for what you have done at that time. Do you know how much or how little — do what you know how to do well.
Anna Varga, systemic family psychotherapist: «Follow the methodology»
Remember, when you work with a family, you are dealing with a real group of people. This is not the same as a therapy group that has come together specifically to participate in a psychotherapy project, or one person who has come to the rescue. Family members may have different attitudes towards psychotherapy. Some see the need for it, some don’t. So you are dealing with motivated and unmotivated people at the same time. The family is a group of different ages, it can include old people, children, and teenagers. They are all present at the session, and you communicate with them all at once, this is not easy.
Do not rely on the idea that the psychotherapist works «with his personality», use the methods and techniques invented by the founders of family therapy. They will help you engage all family members in communication, create motivation for someone who did not want to ask for help, and some common working understanding for everyone. Be sure to enter into a psychotherapeutic contract. Make sure that all family members understand why they are visiting a psychotherapist and what goal they will achieve in the end.