My Therapist's Journey Part 1: Insight.

I've learned so many different types of therapies over the past 20 years and continue to take from everything I’ve ever learned. In a series of posts, I'm going to share what I've personally learned about therapy and becoming a therapist. I hope these posts help future therapists embrace their own journeys and help patients feel more informed and empowered to seek good and smart therapists rather than good and smart therapies that fit their needs in their current moment. 

Chapter 1: Psychodynamic Psychotherapy

Back in the mid 1990s, the bulk of my training was in traditional, insight-oriented psychodynamic psychotherapies. The assumption of insight-oriented therapies, as far as I could tell was that insight alone was therapeutic. The idea is that knowing why one does something can either help one choose to act differently or if it can’t change behaviors, it will at least provide some comfort in accepting who one is. I myself was in a weekly psychodynamic psychotherapy, which I think is a requirement for any good therapist worth his or her salt. There were times in my own sessions when I would ramble on for 40 minutes, and then my therapist would make one piercing observation that suddenly illuminated the thread connecting my rambling thoughts into a pattern or theme that helped me understand myself a little more. I would leave these sessions amazed at the newfound self-discovery. I also remember loving Yalom’s short stories on this approach, called Love’s Executioner and Other Tales of Psychotherapy

I worked tirelessly to make such insights for my own patients both in the sessions and with my supervisor. Then, I would try to gently offer the insight in graded fashion to make it more palatable to the patient. However, to be honest, there were also many times in my own therapy when my effort to gain self-insight only left me feeling more ugly and base as a human being. And, similarly, some of my insights for my patients were hurtful and denigrating. In my training, I was instructed to be judicious and cautious about my insights for the very fact that they could feel so shaming and revealing. This tendency towards negative, possibly destructive insights are especially prevalent in classic psychoanalytic paradigms that assume that a sex-crazed, aggressive Id is ultimately fueling all psychic energy (originally Freud’s Drive theory). 

Additionally, there were often many times as a budding therapist that I couldn’t effectively figure out how to transfer the insights I was making in supervision to something actionable in the sessions with my patients. In worst case scenarios, I would feel so excited about a new insight that I would try to forcibly introduce it into the conversation and my patients would often feel perplexed and misunderstood. 

Technically, my other complaint about psychodynamic psychotherapies has to do with the notion of neutrality and countertransference, and ultimately dyadic power. The classic analytic/dynamic therapeutic stance is that the therapist remains as neutral and inscrutable as possible. This way a person's own internal transferential patterns of relating become projected cleanly onto the patient-therapist relationship so that it can be cleanly analyzed without interference from the therapist’s own counter-transferential patterns of relating. This belief is why so many dynamically trained therapists are so flat, unresponsive and inscrutable. I personally found this passive stance to be wholly unnatural and uncomfortable. It was incredibly unfamiliar for me to act like this as a therapist, and it made me pretty uncomfortable as a patient and extremely uncomfortable as a supervisee. I couldn’t read the other person, which made me feel extremely unsafe, vulnerable and biased towards believing that they didn’t like me. When a loved parent does this to their infant (which is what happens in the Face to Face, Still Face paradigm), babies hate it and angrily cry at their parent to be responsive to them. Why wouldn’t patients feel the same with their therapists, who are supposed to help them feel safe and secure while they share the most vulnerable parts of themselves!?

Neutrality also goes against the grain of culturally competent psychotherapy. Whenever there are cultural differences between patients and therapists, neutrality can often come to replicate or enhance patterns of oppression and differentials in power, particularly when the therapist is White and the patient is not. Being Asian, the rules of engagement were different. First, I was not used to acting this way, especially with other Asians and often with other people of color. Asian people would think I was acting White if I tried to be neutral. There are in-crowd rules of engagement that people from another culture are often not privy to. 

The other thing I really disliked occurred with this one boy who was forced to come to therapy but refused to speak. I was told to let this happen for months and months if need be and to sit and wait for the boy to speak. My supervisor would question me critically if I felt the need to speak and wonder what about my own issues was driving this. 

Even though it feels like I’m ending on a negative note, it is true that I continue to think very dynamically and sometimes make insights and observe patterns in relationship with my patients. It’s just not the principal thing I do and it’s not what I think is the most therapeutic tool in my toolbox (though I’d be curious to hear whether other people felt that insight alone was incredible healing for them). 

Next time, I’ll talk about how play therapy helped meet my need for authenticity and spontaneity.