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Use Your Own Feelings as Data

ne of our major tasks in therapy is to pay attention to our immediate feelings-they represent precious data. If in the session you feel bored or irritated, confused,

sexually aroused, or shut out by your patient, then regard that as valuable information. This is precisely why I so emphasize personal therapy for therapists. If you develop a deep knowl- edge of yourself, eliminate the majority of your blind spots, and have a good base of patient experience, you will begin to know how much of the boredom or confusion is yours and how much is evoked by the patient. It is important to make that distinc- tion, because if it is the patient who evokes your boredom in the therapy hour, then we may confidently assume that he is

boring to others in other settings. So rather than be dismayed at boredom, welcome it and

search for a way to turn it to therapeutic advantage. When did it begin? What exactly does the patient do that bores you? When I encounter boredom I might say something like this:

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66 THE GIFT OF THERAPY

"Mary, let me tell you something. For the last several minutes 1 notice that I've been feeling disconnected from you, somewhat distanced. I'm not sure why, but I know I'm feeling different now than at the beginning of the session, when you were describing your feelings of not having gotten what you wanted from me, or last session, when you spoke more from the heart. I wonder, what is your level of connection to me today? Is your feeling sim- ilar to mine? Let's try to understand what's happening."

Some years ago I treated Martin, a successful merchant, who had to take a business trip on the day of therapy and asked me to reschedule his hour to another day in the week. I couldn't arrange this without inconveniencing my schedule and told Martin we'd have to miss the session and meet at our reg- ular hour the following week. But later, as I thought about it, J realized I would not have hesitated to rearrange my schedule for any of my other patients.

Why couldn't I do this for Martin? It was because I did not look forward to seeing him. There was something about his mean-spiritedness that had worn me down. He was unceas- ingly critical of me, my office furniture, the lack of parking, my secretary, my fee, and generally began sessions by referring to my errors of the previous week.

My feeling worn down by Martin had vast implications. He had initially entered therapy because of a series of failed rela- tionships with women, none of whom, he thought, had ever given him enough-none was sufficiently forthcoming with her proper share of restaurant or grocery bills or birthday gifts equivalent in value to the ones he had given to them (his income, mind you, was several times greater than theirs). When they took trips together, he insisted that they each put the same amount of cash into a "travel jar," and all traveling

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67Use Your Own Feelings as Data

expenses, including gasoline, parking, car maintenance, tips, even newspapers, be paid for out of travel-jar cash. Further- more, he groused often because his girlfriends did not do their full share of driving, trip planning, or map reading. Eventually Martin's lack of generosity, his obsession with absolute fairness, and his relentless criticism wore out the women in his life. And he was doing exactly the same to me! It was a good example of a self-fulfilling prophecy-he so dreaded beinguncared for that his behavior brought that velY thing to pass. It was my recogni- tion of this process that permitted me to avoid responding crit- ically (that is, take it personally) but to realize this was a pattern that he had repeated many times and that he, at bottom, wanted to change.

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Frame Here-and-Now Comments Carefully

ommentary on the here-and-now is a unique aspect of the therapeutic relationship. There are few human sit- uations in which we are permitted, let alone encour-

aged, to comment upon the immediate behavior of the other. It feels liberating, even exhilarating-that is precisely why the encounter-group experience was so compelling. But it also feels risky, since we are not accustomed to giving and receiving feedback.

Therapists must learn to package their comments in ways that feel caring and acceptable to patients. Consider the feed- back about boredom I gave in the last tip: I avoided using the word "boring" to my patient; it is not a productive word; it feels like an accusation, and may (or should) elicit some spo- ken or unspoken sentiment such as, "I'm not paying you to be entertained."

It is far preferable to employ terms like "distanced,"

Frame Here-and-Now Comments Carefully 69

"shut out," or "disconnected"; they give voice to your wish to be closer, more connected, and more engaged, and it is difficult for our clients to take umbrage at that. In other words, talk about how you feel, not about what the patient is doing.

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All Is Grist for the Here-and-Now Mill

; verything that happens in the here-and-now is grist for the therapy mill. Sometimes it is best to offer commen-

d;;:" .i tary at the moment; other times it is best simply to store the incident and return to it later. If, for example, a patient weeps in anguish, it is best to store a here-and-now inquiry until some other time when one can return to the incident and make a comment to this effect: 'Tom, I'd like to return to last week. Something unusual happened: You trusted me with alot more of your feelings and wept deeply, for the first time, in front of me. Tell me, what was that like for you? How did it feel to let down barriers here? 'To allow me to see your tears?"

Remember, patients don't just cry or display feelings in a vacuum-they do so in your presence, and it is a here-and-now exploration that allows one to grasp the full meaning of the expression of feelings.

Or consider a patient who may have been very shaken dur- ing a session and, uncharacteristically, asks for a hug at the end. If I feel it is the right thing to do, I hug the patient but

All Is Grist for the Here-and-Now Mill 71 r

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never fail at some point, generally in the following session, to return to the request and the hug. Keep in mind that effective therapy consists of an alternating sequence: evocation and expe- riencing of affect followed by analysis and integration of affect. How long one waits until one initiates an analysis of the affec- tive event is a function of clinical experience. Often, when there is deep feeling involved-anguish, grief, anger, love-it is best to wait until the feeling simmers down and defensiveness diminishes. (See chapter 40, "Feedback: Strike When the Iron Is Cold.")

Jane was an angry, deeply demoralized woman who after several months developed enough trust in me to reveal the depth of her despair. Again and again I was so moved that I sought to offer her some comfort. But I never succeeded. Fverv time I tried I got bitten. But she was so brittle and so hypersen- sitive to perceived criticism that I waited for many weeks before I shared that observation.

Everything-especially episodes containing heightened emotion-is grist For the mill. Many unexpected events or reac- tions occur in therapy: Therapists may receive angry E-mail or calls from patients, they may not he able to offer the comfort desired by the patient, they may be deemed omniscient, they are never questioned, or always challenged, they may be late, make an error in billing, even schedule two patients for the same hour. Though I feel uncomfortable going through some of these experiences, I also Feel confident that, if I address them properly, I can turn them into something useful in the thera- peutic work.

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Check into the Here-and-Now Each Hour

make an effort to inquire about the here-and-now at each session even if it has been productive and nonproblematic. I always say toward the end of the hour: "Let's take a

minute to look at how you and I are doing today." Or, "Any feel- ings about the way we arc working and relating?" Or, "Before we stop, shall we take a look at what's going on in this space between us?" Or if I perceive difficulties, I might say something like: "Before we stop, let's check into our relationship today. You've talked about feeling miles away from me at times, and at other times very close. What about today? How much distance between us today?" Depending on the answer, I might proceed to explore any barriers in the relationship or unspoken feelings

about me. 1 begin this pattern even in the very first hour, before a great

deal of history has been built into the relationship. In fact, it is particularly important to start setting norms in the early ses- sions. In the initial session, 1 make certain to inquire about how patients chose to come to me. If they've been referred by some-

Check into the Here-and-Now Each Hour 73

one, a colleague or friend, I want to know what they were told about me, what their expectations were, and then how their experience of me even in this first session has matched those expectations. I generally say something to this effect: "The ini- tial session is a two-way interview. I interview you but it is also an opportunity for you to size me up and develop opinions about how it would be to work with me." This makes eminently good sense, and the patient usually nods at this. Then I always follow up with: "Could we take a look at what you've come up with so far?"

Many of my patients come to me after having read one of my books and, consequently, it is a part of the here-and-now to inquire about that. "What specifically was there about this book that brought you to me? How docs the reality of seeing me match those expectations? Any concerns about a therapist who is also a writer? What questions do you wish to ask me about that?"

Ever since I wrote about patients' stories in a book (Love:, I~xecuti()ner) many years ago, I assumed that new patients con- sulting me might be wary of being written about. Hence I've reassured patients about confidentiality and assured them that I've never written about patients without first obtaining permis- sion and without using deep identity disguise. But in time I have observed that patients' concerns were quite different-in !',cneral they were less concerned with being written about than with not being interesting enough to be selected.

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