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This blog is about---You! Each and every post is about you. Use it to challenge your usual patterns, as a tool for self-discovery, to stimulate your thinking, to learn about yourself and to answer your questions about others.

Friday, September 21, 2012

Search Keywords/It Takes Two to Tango

A seeker who made me think
 "Taking care of your therapist" is the phrase that appeared on the search keyword list that Google provides for me.  And, oddly, it was there more than one day.
Usually I don't do anything about these search words as I can't know what they mean.  That's why I am always encouraging you to comment  on the blog---because I do want to know what is on your mind.

This cryptic phrase stuck with me for some reason.  It made me think.  Usually, of course, we all naturally view the psychotherapy relationship as pretty much one-sided.  A person who seeks out a therapist is not looking for someone to take care of; they are hoping to find help for themselves.  And, yet, as I continued my work with my patients and this mysterious shred of a sentence stayed with me, I began to notice something.
While the lion's share of the attention in a session is going from me to my patient, there is, in fact, an exchange.  It isn't even or equal and it shouldn't be.  But, it is definitely there.
And, I have been noticing that there is a real range:  There are people who pay attention, consistently, and with great consideration to how they treat the therapist-----all through many versions of everything in between-----to people who will rip off their own therapist.
This last, every time it happens, utterly amazes me.  It just knocks my socks off!  How can a person  finagle a way to not pay either their fee or their insurance co-payment to someone who has given them their compassion, their attention, and their best thinking?  Never ceases to amaze me.

When this happens, it feels de-valuing to the therapist.
Yet, while therapy is on-going, many therapy patients, if not most, can hardly get out the door.  Some are still talking, in the doorway.  They find it very difficult to end the session.  Why is that?  That's because therapy is therapeutic.  It feels good.  It is nourishing to the soul.  To have an intelligent, thoughtful, kind listener is enough to be hooked.  But therapy gives that and a lot more.  It's hard to leave when receiving that kind of attention.  I still don't know how to reconcile this oft-repeated occurrence-of not wanting therapy to end, with the one of cheating or defrauding the therapist.

The last time I was in therapy, I did everything I could to support the relationship with my therapist and to treat him with regard:
This includes simple things like making it to all my appointments, getting there on time, being ready with the payment-whether it is cash or a check and quickly giving it to him at the very beginning of the session, preparing for my session personally, i.e., thinking beforehand about what I wanted to focus on, never bringing my cell phone into the room, staying involved, open, and personally engaged throughout the session, not bugging him too often with in between-session phone calls, listening when he had something to say (not interrupting or cutting him off), occasionally thanking him, not taking it for granted if he did something extra such as get me a referral or talk to my doctor, and giving him specific feedback if he did or said something that had been particularly helpful to me.  If I brought up something or someone we hadn't talked about much or, for a long time, I would cue him in with something like, "My cousin, Ellen, the one I spent a lot of time with growing up..." in case he didn't immediately remember.  Usually he did, but, I just felt it was considerate not to expect him to recall every single little reference I had ever made.  One time, I paid with cash because I forgot my checkbook.  He was so pleased!  Said:  "That almost never happens!"  So, just note that some therapists in private practice find it helpful to be paid in cash.  The point is, just a little attention on the patient's part, can make a big difference.
Some of these things are simple courtesy, a few are coming from a deeper level.  But, it all added up to treating him with regard.  Of course, as a therapist myself, I know what it takes to do what he does.  I don't expect every patient who goes to a therapist to know how they (the therapist) got to that position nor what it takes to stay there.  (And, in fact, I do realize that what takes tremendous effort can, in an experienced person, look quite easy).

But I would hope that, over time, the patient would take in the wonderful combination of caring and thinking that a therapist offers to them.  And yet, it just doesn't always happen.  For some, either it goes unrecognized or unappreciated.
Of course, at the clinical level, it tells the therapist something about the patient's own self care, about how they've been treated previously, and also how they currently function in their relationships with others in their outside life.  Behavior is information. But, for the purposes of this post, I'll not stray off into that kind of analysis and just stick with the therapist-patient relationship.

Some of the things that happen are not quite, but are almost, shocking.  When a long-term client leaves the therapist in the lurch, owing money by tricky means like no-showing the last appointment and not paying for it or not having the co-pay the last few visits, promising to mail it and then becoming unavailable without having settled the account as promised, writing a check on a closed account, and so on, it simply leaves the therapist with a sinking heart.
I used to try and try to get the payment and then, ultimately, after a ridiculous number of attempts, would turn the account over to Collections.  I haven't done that lately as, for me, no matter what the client has done to me, I just can't muddy up the helping relationship with something so punishing.  The intention of therapy is to shine light into the darkness of life, not to add bitter experiences.  So, I absorb the loss.

On the other end of the spectrum, are people who are always responsible for their part, live up to any agreements they've made with the therapist, are considerate of the therapist's time, and pay regularly:
They are generally courteous and show that they are aware that the therapist is a person too.  There is rarely a patient who doesn't miss some appointments (although some never do, without a proper cancellation) but the people at this end of the spectrum always pay for my time.
I've had some who voluntarily gave me a raise (raised their own fee)-yes, believe it or not-and people who have paid, not only the fee for a missed appointment but offered to pay extra for making me sit there and wait not knowing what had happened.  Usually this comes with a sincere apology.  
It is clear, this group has a value for the therapy process and respect for their therapist.  They leave no doubt.

~The world has become a harsher place in recent years.  But the holding experience of a good therapy relationship is a respite from that competitive, confusing world outside.  The therapy office itself can become a container (a confidential container, with boundaries) for your dreams, hopes, fears, worries, wishes and secrets.  It does seem, like the search keyword the writer wrote, to some degree meant, it is fitting to take good care of your therapy and your therapist.~

A good therapy relationship is key to a productive therapy experience.   Most therapists will try to meet you more than half-way.  But, they can't do it all for you.  
Your contribution will be key to the best experience and outcome for you. 

"Psychotherapy is a two-way street:  Both the patient and the therapist must take responsibility for their part in creating the healing relationship." Quoting myself from the post, A Two Way Street

The more that you honor your therapy relationship, the more fruitful your therapy will be.

Pleas write in the comment section about how you feel about how you treat your therapist.


  1. I absolutely love this post. It makes me self evaluate how I treat my 2 therapists. Your definition of "taking care of your therapist" is accurate in meaning respect and courtesy for him/her instead of an emotionally reciprocal relationship. I do my part by being prompt for payments and appointments. I've never missed or rescheduled. I start thinking what I want to talk about at least 24 hours before my appointment and take notes on my thoughts. I don't have anything to distract us, even though my therapists cell goes off often. I have called her one time in the past year to ask about a referral, and I've sent maybe 3-4 emails in the past year with her to let her know that I have something that needs addressing at the next session. On the other hand, I don't recall ever thanking her directly for anything. Also, I usually don't give her feedback for the stuff that's helpful. I have told her maybe twice that I was feeling stuck or misunderstood.

    I would like a blogpost or email that addresses how, at the clinical level, all of this tells the therapist something about the patient's own self care, about how they've been treated previously, and also how they currently function in their relationships with others in their outside life.

    1. Dear Anonymous. Well, I absolutely love this comment! Your 2nd sentence neatly put the entire post into one sentence. What's great for me in your comment is, 1, your enthusiasm---I am happy to have inspired that and 2, your self-evaluation. That is my real purpose here-to help my readers to grow, to introspect, to learn, to try new things, to become more and more who they want to be. Your description sounds like you are a lovely patient. 'Thank you' is always appreciated and your feedback to your therapist helps the therapist to help you.
      I will try to fulfill your request about expanding on what I mentioned about how a therapist can observe behaviors and draw conclusions from that. It's a post that may take a little time---we'll see, but one way or another I'll do my best to fulfill your request.

    2. Paula, thanks for your reply. I'm very passionate about the client/therapist relationship (and therapy in general) since I am a Senior in college earning a Psych degree and also a client. It was after a series of events that happened in my own counseling that I decided to be a therapist myself.


    3. Amy, I hope you will become a member, or subscribe to A Therapist's Thoughts. As a psychology student, it would be delightful for me to hear your comments/reactions.

  2. I love this post. It was very affirming. My therapist is about as human as they come, and she's frustrated me many a time. On the flip side, I know I've also frustrated her many times as well! The best thing though is that she is honest when she's frustrated with me, and I am the same with her. I don't know that I'll ever be able to appropriately express my gratitude for her, and all she puts up with in me. I thank her nearly every time I leave her office, and have, on occasion, left her a message just to say thank you. But sometimes, that doesn't feel like enough. I know that, as you mentioned, I do my part - pay on time, prepare for sessions, am always on time, listen to and try to follow her observations, etc. How do you thank someone who has, on more than one occasion, saved your life? How do you thank someone who has shown you that you are valuable, and for the first time ever, you start to believe it?

    Thank you for this post, it's nice to get the inside scoop on what a therapist thinks about, and how important the relationship really is.

  3. I was looking back at some older posts and saw where you suggested I become a member. Just wanted to let you know that I later joined with the name Bama Psych.

  4. Hi Bama Psych. Welcome to membership! What was your other name?

    1. Paula,

      I was posting as Anonymous, but then signing Amy or at the end of my posts.

    2. Thanks Bama Psych for clearing up my confusion. Now I have a thread, more of a sense of you individually.