Being Therapeutic

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Dave:  What follows is on the subtle side– ideas that might be more for therapists, but there is information here that is useful for thinking about relationships and how they work. These ideas provide support for subtlety, support for veiled realities. They are incomplete ideas intended to stimulate reflection.

I am a psychiatrist, but I do and teach Psychotherapy, more specifically Symbolic Experiential Family Psychotherapy. There are three levels in learning how to be a therapist. First, learning about therapy. Undergraduate training. Second, learning to do therapy. Graduate school. Then there is being therapeutic. Learned by experience and reflection. The following thoughts attend to the realm of “being therapeutic”.

Here’s the thing:

Stimulating change is my intent. That remains fundamental.

My intent is abstract, still patent and simple, grounded in accumulated and infinitely complex experiences—as complex as the interplay of everyday gestures that constitute the way the world already works. If the world seems complicated, when you think about it, it is even worse.

My intent appears in ironic interaction pressuring and guiding people in families toward living, not as objects, perpetually wronged, but as subjects, living as if their experience actually depends on who they are, what they do—and that opens onto a pathway along the edge of freedom, grounded in creativity.

images-10Fear and outrage go hand in hand in our world. There is plenty to be mad about; big government, home and family, liberals, schools and teachers, intellectuals, play and sex, socialists, gender imbalances, God, doctors of uneven ability and multiple messages, Obama, endless bureaucratic directives.

But here is the thing, being outraged is gratifying, being angry is a turn on. But the weird irony is that being perpetually outraged and/or fearful is how humans lock themselves into being objects; waiting disappointed double-crossed victims. All the problems seem like givens, like natural facts. But something can happen in therapeutic experiencing that makes it possible to see all these impossible problems as if they are weird word constructs: problems that have been made and therefore can be altered, transcended or bypassed, even done away with altogether.

Unknown-1Greil Marcus said something like this about rock and roll lyrics (Lipstick Traces) . I adapted it to match my therapeutic purposes. Songs do something for the spirit whether they are understood properly or not. What I do and write about is experiential therapy. It is an art, it is something like music. The therapy is in part performance. I think that real therapy is beyond interpretation. It is not about me taking in what you say and telling you what it means. It is not about increased knowledge. If knowledge really helped than all of us therapists would be grown-ups. Insight follows experience.

I am making suggestions about how to think about experience. In my case, as therapist, I give little, virtually no advice. I think that what is therapeutic is discovering a way of thinking about experience. When I first entered Psychiatry, I was looking for a catechism to help me be a therapist. I wanted it to be the way it was in Medicine.

Impeccability…is not morality…it only resembles morality. Impeccability means not compromising my integrity, impeccability means the ability to disappoint. Impeccability is not 51sV4WIBxkL._UY250_morality it is simply the best use of our energy level. Naturally, both integrity and impeccability are enhanced by frugality, thoughtfulness, and simplicity, (Castaneda, The Power of Silence). Impeccability provides the courage to be vulnerable. Don Juan makes the point that impeccability stores energy. The energy of importance is a manifestation of “therapeusis,” the abstract core of therapeutic process. But the energy of therapeusis is also the energy of intent.

Impeccability, energy and intent are important in all caring relationships. Abstract intent, a not-defined concept, blends consciousness and unconsciousness. Intent comes from intuition. It is expressed in attention. It exists in presence, the measure of a person’s bearing. Abstract intent guides therapeutic play. The capacity for therapeutic abstract intent develops with experience. The capacity for abstract intent is what adds control to the process. This capacity for abstract intent is fundamental to what we think of as “being therapeutic.” It is the support membrane for language, for “presence.”

The person who is the patient learns something about how to think from the therapist. That is the realm of psychotherapy, which is different from psychoeducation or from counseling.

Thinking and saying exactly what you want to say requires great amounts of energy. You often go a wrong or fruitless way. You are trying to remember thoughts the way you normally do, the way a student might do, but this is a different situation. You had a strong memory, but you cannot recollect with memory. You have to recall these thoughts by intending them back. The situation may evoke a related memory or an image.

Here is an illustration of the effects of abstract intent: A 17-year-old girl, who had been disciplined by her father, took an overdose that would have been lethal if her younger sister had not caught her in the act of ingesting pills. I worked with them for two years. Therapy ended when the daughter who made the suicide attempt left for college. Two years after that the father called to say things were going well enough, but they wanted to come in for a checkup. The interview was a warm review of what the family was doing. Near the end of the time, the father, a hard-headed business executive, said, “I have thought a lot about this, and I don’t exactly know what I want to say, except ‘Thank you’ doctor. This therapy thing, which I had little confidence in at the beginning , has been helpful, but in ways I never expected. I got a lot out of it.” Then he smiled and added, “But Dr. Keith, you never said anything.”

images-6I have heard versions of that comment many times from bemused and appreciative customers and from frustrated disappointed customers. It is not true that I don’t say anything. I think I say a fair amount. I acknowledge being cryptic. What I figured out is that there is something critically important conveyed outside of any words. It is conveyed by intent.

These are important ideas but slide outside of conventional ways of thinking about caring relationships. Take plenty of time to digest them. Beware: Reason will lead you astray.





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