Friday Post-Mortem

This week I saw an exceptional number of psychotherapy patients in five days, and I noticed a few things:

a) It took a lot of energy and, even though I enjoyed many of the sessions, I was noticeably drained by the end of the week.

b) I joked around in therapy more than usual and told more quasi-personal anecdotes.

c) My patients didn't necessarily like it.

I've been thinking about how the first two observations are related and I think I've cracked the code: Therapy takes a lot of energy because you have to be thoughtful and mindful and helpful and insightful, but an additional element that takes considerable energy--for me, at least--is not being totally myself. It's not that I'm a blank automaton with my patients, but in therapy, I don't make express opinions or preferences, make jokes, seek support, gossip, compliment, or reassure, and I rarely give advice. If a patient is telling an anecdote and I've experienced the exact same thing I don't say "Oh my God, me too!" If a patient is recounting a dilemma, I can't tell him what I'd do if I were in his shoes.

I think the extra jokes and quasi-personal anecdotes this week represent a kind of resistance to the additional hours of personality suppression. When a patient mentioned that the hospital security guard made a weird comment to him, I said "Yeah, he's done that to me too a few times, he's kind of an 'unusual' guy," rather than "What was that like for you?" When a patient reported that she didn't work out this week, I said "Yeah, it's not always easy to get to the gym after work, I've had weeks like that," rather than "What were some of your obstacles?" These responses weren't particularly out of line, but they weren't particularly helpful either. 

Finally, I think that this kind of over-sharing is confusing for the therapy relationship, and here's why: I'm particuarly likely to joke or to reveal glimpses of my personal life in session with patients who are similar to me--patients who have the same sense of humour or the same personal conflicts as me, who live in the same neighbourhood as me and have a similar lifestyle, or who share my cultural or academic background. But although I know that we have a lot in common, patients aren't aware of our similarities. So if I suddenly mention that I too am attending a Passover seder this year or that I too experience daily frustration with the ongoing construction at the subway station nearest both our homes, it comes out of the blue. It's also worth remembering that I've had therapists who shared personal details about themselves with me, and that I disliked it and preferred to maintain our one-way relationship. My own patients may not feel this way, but it's my responsibility to err on the side of reticence.

Reining in your own opinions and preferences and experiences isn't easy and explains why therapists can feel isolated despite interacting with people all day. For the therapist, psychotherapy doesn't meet the need for communication because it's not reciprocal. All the more reason to keep up my usual strategy of calling up a friend or family member for a brief chat when I have a break in my day, and why I like the idea of mixing private psychotherapy practice with other pursuits.