Shrink Rap: Beyond the Spoon
Originally published in Coast Magazine, November 2006
A recent column in The New York Times by a psychiatrist made the point that understanding and empathy in psychotherapy just aren't enough for people to change. He insisted that in a "blame addicted" culture, it's bad therapy to facilitate patients whining about the past and blaming others for their misery rather than learning to take responsibility for their lives in the present.
It's not that our early conditioning and experiences don't influence our present — of course they do. It's that too many patients use their past as a crutch for not addressing life in the present. They want to use their "good excuses" for having problems rather than growing past them.
Many come to treatment expecting to be given what I call "spoon-feeding." Too weak to feed themselves, they are like fragile baby birds wanting their psychological nourishment to be served up one spoonful at a time. Empathy, emotional support, and unvarying acceptance of their thinking and behavior are what they are looking for — not real change. Usually, they don't have anyone who listens closely to them in their everyday life.
Those coming from a past of serious deprivation and trauma need to be given an ample dose of spoon-feeding. You can't "shrink" an ego that has been insufficiently developed. But my feeding lasts only as long as it takes for them to become strong enough to begin feeding themselves.
It is often surprising for new patients to discover that being understood and receiving empathy alone are not what good psychotherapy is about. After all, they feel so warm and fuzzy — what's not to like? And yet for those whose ego-strength can handle it, engaging in gentle challenge and head-on confrontation are what lead to new insights and changed behavior. They also lead to feeling more responsible and accountable for your behavior.
Sometimes confrontation can be intimidating and make patients defensive and angry. And it can make therapists seem like they're not kind and caring. But the most successful and proficient psychotherapists don't worry about winning a popularity contest. They know that not everyone is coming in to change and that some will exit as soon as they are confronted with painful truths.
The popularity of modalities like Cognitive-Behavior therapy and Gestalt therapy has to do with their ability to help people mobilize their strengths in the here-and-now. These approaches do not rely primarily on exploration of the past, even though those trained in them should be adequately trained to take that journey if warranted.
While it is important to develop a trusting connection with the person you choose as your psychotherapist, be wary of those who are heavy on spoon feeding or who just sit back and smile benignly as they listen to you. Best to find someone who is active, who engages you in dialogue and isn't afraid to disagree or challenge you as a regular part of the process.
No matter the modality or therapist's personality, if you leave every session feeling warm and fuzzy, you need to question whether you're getting good, constructive therapy. Conversely, if you leave the session occasionally unsettled, emotionally drained, or mentally challenged or confused and you think about what happened for hours or even days after, then it's a good sign that you're on the right track.