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What Does My Therapist Really Think?
101 Plays4 months ago
In this episode, Fara and Grant approach the sticky subjects in therapy, such as: billing, scheduling, boundaries, connection... and whether I really AM my therapist's favorite patient!! They provide insights into the challenges associated with managing this relationship and offer guidance on how to effectively communicate with your therapist. How do you bring up your concerns? Is it wrong to feel emotionally or romantically attracted to your therapist? This episode covers a wide range of topics to hopefully ease some of your anxieties.
We hope you enjoy.
Key Takeaways:
Therapists, like anyone else, have their unique ways of approaching therapy based on their training and sensibilities.
If you ever feel uncertain or have questions about your therapy, please don't hesitate to bring them up with your therapist. It's important to work through any concerns in your relationship with your therapist, and they are there to take them seriously and support you.
In This Episode:
[0:00] Introduction
[01:00] Episode Overview
[03:15] Getting to Therapy on Time (...or not)
[07:30] Balancing Scheduling and Boundaries
[12:10] Adapting Therapy Practices
[15:10] Professionalism and Remote Therapy
[19:40] Ethical Boundaries in Therapist-Patient Relationships
[24:50] Handling Multiple Sources of Advice
[31:47] Am I Your Favorite??
[38:53] Therapeutic Obligations
Resources and Links
Doorknob Comments
https://www.doorknobcomments.com/
Dr. Fara White
https://www.farawhitemd.com/
Dr. Grant Brenner
https://www.granthbrennermd.com/
https://www.linkedin.com/in/grant-h-brenner-md-dfapa/
Recommended
Transcript
The Quest for Approval in Therapy
00:00:00
Speaker
You know and in general human beings you know there's some variation from person to person but we need and want to be liked and that's true for everyone including therapists.
Meet the Hosts: Dr. Fair White and Dr. Grant Brenner
00:00:11
Speaker
Hello i'm dr fair white and i'm dr grant brenner. We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the doorknob comment. Doorknob comments
Unveiling Doorknob Comments
00:00:26
Speaker
are important things we all say from time to time just as we're leaving the office, sometimes literally hand on the doorknob. Doorknob comments happen not only during therapy, but also in everyday life. The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking, and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them. Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out.
00:01:00
Speaker
Hi, thanks so
No Guest Episode: Exploring Therapist Emotions
00:01:01
Speaker
much for tuning in into doorknob comments today. and We don't have a guest, so it's just me and Grant here. And I had something that I wanted to talk about because it's come up a few times in different ways over the years. Just this idea of whether therapists can be annoyed or angry about certain things. So we I wanted, I did like, a tiny bit of research and I wanted to talk about some things that patients think might annoy their therapist and whether they really do or don't. We'll go through a couple of things.
Therapists' Perspectives vs. Patients' Perspectives
00:01:42
Speaker
Some
00:01:44
Speaker
may seem a little bit superficial and we'll talk about sort of the deeper meaning behind them. Some you may have come across in your own therapy or wondered about. May I jump in for a sec? Yes, you may. One of the things you shared was a Reddit sub thread about people who had negative experiences with their therapists, which is completely valid. I think it was like about ick, like ick things that make patients go ick. So I think one thing is like, you know, um, you know, I've been in therapy.
00:02:15
Speaker
So it's not so much us and them in my point of view, from my point of view. And I was reading that sub-thread and there were a lot of things that were cringe-worthy. And of course, it's it's only one side of the story you know that can always be the case ah with any kind of two or more people. you know If you ask them, everyone's going to give a different story. I do think there are valid critiques of therapy, some of which we've covered. But I really don't want people listening to this to think of it as kind of an us versus them thing. And I think part of your intention is to debunk that idea. Exactly. So the reason that I sent you, I sent you two things. One was the what do patients do that might annoy their therapist. And the other was what's your therapist do that gives you the X. So that will be like kind of a follow up. I didn't catch the first one.
00:03:04
Speaker
what do patients do that might annoy their therapist? No, I heard you right now. I didn't see the the first thing. Oh, okay. I only saw the second one. That explains why we didn't address it. So
The Lateness Dilemma in Therapy
00:03:17
Speaker
I guess the point is that there are a lot of times where these things happen in passing and any individual therapist-patient duo might not actually address it, even though I kind of think they should. Sometimes it's just not realistic. So the first one that I wanted to talk about is either being late, missing appointments, scheduling, and rescheduling, and how different people and therapists might see it. Because um some patients, I think, worry about doing that or they stress about being late for an appointment. What do you think?
00:03:55
Speaker
So, you know, stepping back, doorknob comments, podcast, we're looking at things that are easy to overlook. We're trying to slow down and pay attention to the things that we might make assumptions about. So when you ask me about time, and oh, what if someone's late? Well, lots of different therapists and and people in general will have lots of different reactions to being late. I know therapists who are very, very much like by the clock, And that's very traditional, almost old school, and will interpret it as meeting something very significant if someone is late, particularly if it's a pattern of lateness. And that would fall under something called transference, like the things that patients are dealing with in their day-to-day lives get played out and projected onto the treatment frame.
00:04:47
Speaker
Do they have some reluctance or resistance to therapy? Or is this a pattern that they had? Maybe their mother was always late to pick them up from school. And if you dig into that a little bit, there's an underlying emotional conflict about being on time. And then to your point, well, what is that patient imagining that their therapist is thinking? Or for example, are they imagining their therapist is chill about it? Or are they imagining their therapist is getting more and more frustrated? you know Just you know critical about it, annoyed, right? And if you don't talk about it, if you don't bring it up in therapy, which it's always a good idea to try to bring things up in therapy and see how it goes. If your therapist doesn't handle that well, that's something important. You know, you may question the fit with that therapist. What I would say is, you know, don't just post about it on Reddit though. Bring it up with your therapist. Right. Or as some of the therapists. I searched up your name on that Reddit thread by the way. Yeah, thanks, what came up.
00:05:45
Speaker
No hits. Oh, that's a relief. um But the other piece of it is sometimes we look at these things as your right communications, but we also know, for example, that if we're working with someone who struggles with ADHD, that they might have trouble managing time. That would be a mistake on the therapist's part to ascribe that to some hidden meaning. i've I've heard, I've heard terrible scenarios where people who who do have ADHD get into like a situation where the therapist keeps wanting to explore what it means and misses the diagnosis of ADHD and delays treatment. You know, it's usually both. Like I have that conversation all the time. If someone forgets something, how much of it is ADHD and how much of it is related to some unconscious feelings about it. And, and, you know, When you say it can be both, that also means it sort of interacts. So if you, if there's ADHD and there's some conflict about, you know, remembering someone's birthday or something, then it's going to be a double whammy. Right. Right. But I think that the basic thing that I want listeners to know is that most therapists don't look at this in the same way. If there's something that, and this will keep coming back to, if there's something that
00:07:04
Speaker
it feels annoying or angering, right? It's our job to be able to bring that up with the patient in a non-shaming way and just saying, hey, I noticed that you're late and maybe it's because you can't get away from work or maybe it's because you have trouble estimating how long it's going to take you to get up here or, you know, what can we do to work together so that people make their appointments? I think the
Balancing Professional and Personal Life in Therapy
00:07:32
Speaker
scheduling and rescheduling And I know that we have very different views on how we manage our calendars, right? And that's just like a small snapshot of how many different therapists there are and how they work things.
00:07:48
Speaker
Well, yeah, you say you say very different, but Freud had this idea of the narcissism of small differences. There's probably way more similarities than differences. I think one thing that's important for people to know is that for most therapists, right, this is our livelihood and we have other stuff that we do. We have often have families and other obligations. And I think there's a way, you know, when I've been a patient in therapy, um there's a way where I want to be like, you know, the center of the therapist's world. And there's also a way where people sometimes don't want to think about their therapist as a person. And there's a way where it's important for the therapist not to be in the way as a person. And so I think when a therapist has a lot of scheduling issues, and I see this with billing too, I hear people complain about um like therapists who don't do their bills on time or who don't follow up or you get a bill four months later for three months of therapy and um It makes people doubt the security of the therapy relationship if it looks like their therapist has a problem. Along similar lines, I think on average most people will have fantasies about what their therapists are like outside of their therapist role. And so coming back to your point about scheduling, yeah, yeah like I try to be a little bit more
00:09:05
Speaker
you know i'm I'm not as flexible with short-term scheduling changes. Though in reality, I usually am. If I can change something, I will. I'm not draconian. I know there are therapists who are draconian. yeah It's kind of like, this is your time, and that's it. yeah And I have a one-week cancellation policy. I have like ah a one a one-day or a two-day cancellation policy. I actually rarely charge for missed appointments. I will almost always try to reschedule them. you know So there's flexibility around those rules. I think you're alluding to the level of flexibility around these rules. You you on the other hand, how how would you describe the way you approach scheduling? well It's also your own convenience, right? If you're juggling 10 different appointments at the last minute, that may not work so well with a busy outside life.
00:09:53
Speaker
true, but what I try to do is extend my patients the same level of flexibility that I would like them to extend to me. And because I do have a busy outside life, I feel like if I were, you know, stringent about, well, this is within, you know, I understand things come up, but I still have to charge you for this appointment. One, I know that that person is probably not going to then if their appointment was on a Tuesday, I'm not gonna probably see them on that Friday, because most people maybe are not gonna pay for the two appointments a week. But also, I never wanna set up of some sort of a frame that I can't maintain myself. Now, I guess, I don't know if that's controversial. I also make a- What do you mean by you don't know, sorry to interrupt, but what do you mean by you don't know if that's controversial? How would it be controversial?
00:10:51
Speaker
Because a lot of people, like, I don't know when you've been a patient, but have you ever had a therapist cancel on you within 24 hours, right? Let's say that's their policy, but they cancel on you, then what, do you get a credit? Do you get a free session? What's the controversial piece? There are different relationships and roles and responsibilities, right? right One person is, you know essentially, I think of myself as working for my my patients. right um if i So if I need to cancel something, they may not have their appointment, but you know I don't owe them a fee. they They would owe a fee. So I think it's asymmetrical. i So i think I think one way for listeners to think about this
00:11:36
Speaker
is to think about the ways that the relationship is, you know, it sounds wonky, like symmetrical and asymmetrical, right? You're, you're providing a service for people. And so the rules aren't going to be exactly the same, right but that's kind of a fantasy. Like if I cancel, then maybe I should give them a credit, but it's actually, that's not reality-based. That's not reality-based, but I'm saying that thought is why I'm sometimes less like, you know I try to give as many allowances as I can because I feel like I'm going to be on the other side of that. If I were analyzing you and if I were an annoying analyst, I would probably like jump on the word allowance because that's like a fee that parents pay their children or something and give allowances. but
00:12:23
Speaker
um So I mean, the traditional response would be like, well, maybe that's your counter-transference, right? Maybe you have some feelings of guilt, um or maybe you have conflict in your own life that um it's hard for you to balance your work life. And so you end up trying to make up for it by showing how much you care, by being very, very flexible. And that works for you probably in some ways and not in other ways. And this is the kind of thing that I've you know ive heard, like, I've been in the field of, you know,
00:12:54
Speaker
just only a little bit longer than you, so really not that much longer, but over and over and over again over the course of the last couple of decades, I hear people talk about kind of keeping the frame right and and sort of not getting into that slippery slope where you end up feeling conflicted about scheduling. Yeah. I'm much more comfortable with it now, but I do think that these are all things to consider and that people, you know, my policy is just, if something comes up, I want to know as soon as possible, mostly because I very frequently and because of the way my practice is structured, and not everybody who probably needs or should has a weekly set time. So I do frequently have people who could use the session.
00:13:41
Speaker
if someone can't make theirs. And that also helps me because then i I'm not sort of thinking about, oh, a little bit of money that I didn't make. and It's all the same to me because... Yeah, it's it's what works for you. Yeah. So that's probably not the standard model, but that's fine. we We live in a time when, you know, you don't have to follow all these old rules for no reason. Yeah. at um And sometimes, you know, but what you, lose what you, what you lose out on is some of the predictability in the near term. So sometimes there's some chaos. There might be, you're worried about double booking and four different appointments. star Yeah. Yeah. I know. Yeah. These are, you're on the move. Yeah. yeah But that's your style.
00:14:27
Speaker
Yeah. Yeah. And it's okay. And it's also okay if it doesn't work for everyone, right? But I have now been able to accept that that is my style and it yeah yeah but I think that you know the the risk there is that over the long haul, you may feel that people have too much access to your time because they've become accustomed to you being like hyper responsive in a short timeframe. And if you start saying, I'm i'm not available, you know a I don't have an extra slot. Or if you start saying to yourself, you know
00:14:59
Speaker
I really want to stop working by sex, period, every day, unless it's a medical emergency. I'm not going to make myself available. That would be, you know, you would have to make some transitions. Right.
Remote Therapy: A New Era
00:15:12
Speaker
That's reminding me that I want to move on to our next topic, which is probably the more straightforward or superficial one, which is, okay. how people dress or whether they eat, like if they look at their phone during the therapy session and does that stuff actually really matter to us or not? Especially with video sessions when people have the option and the opportunity to to to be very casual.
00:15:43
Speaker
um So i I hear this a lot. especially So especially with video sessions, I hear a lot of variability from therapists. So there's an idea that it should be professional, right? Like you should be wearing clothing. um You should be you know sitting up in in a ah quiet, confidential space. um you know What happens if a patient gets on a video call and they're in their bedroom and they're there you know their grandmother is in the background and it's not confidential. And it's similar to the time question because it's kind of like you use the word stringent. you know like Are you going to be stringent? Are you going to say, can't have a session now? And do you tell people up front, listen, here's
00:16:25
Speaker
here's what the expectations are. Certainly it has to be private and confidential, but you know please also be in a sort of a professional, or maybe professional isn't the right word, but appropriate I hate using this word, but yeah, appropriate. yeah On the other hand, you might be thinking, well, I can learn a lot more from video sessions. And that's been true. I see things not just in the patients, kind of how organized their apartment is or something like that, but even things like home decor or art selections sometimes can be meaningful. And in that sense, it's more symmetrical because in the conventional model, people get to see your office, which of course is professional by design, but you don't get to see what happens in their life.
00:17:08
Speaker
Exactly. So I think it's one good information that tells us a little bit about what's going on in people's lives. And and you get to meet their cats. yeah You get to meet their cats, you get to hear their kids screaming in the background, and you know they may get to hear ours. and That stuff really doesn't bother me. You're like an open book. That's so cool. No, I'm just saying. You're so cool. that no no I'm not saying that. You're like a hippie therapist. Maybe a little bit. but You don't come across that way, you know? Yeah, but I guess. You don't wear chunky jewelry. You don't wear... Not yet. I am attracted to it though. Are you? and Kind of, yeah. That's kind of what I aspire to be. What do you aspire to be?
00:17:56
Speaker
I don't know. It's just ah seems very free. Like if I were like in prairie skirts and turquoise jewelry, like, you know, it just seems like yeah really nice. And I think that are acceptable. It is totally acceptable as a therapist. I don't know that it would be acceptable for me as a person. And so I like in my personal life. Do you like the smell of patchouli? No question. Oh, I didn't know that was what you were asking. I can't answer that yet. But I think that people should show up in therapy the way they would show up in the world. So if they don't wear a bra regularly, they don't need to come to therapy wearing a bra. But but but okay. let me a draft card i no no I'm just saying like,
00:18:51
Speaker
It's important because that's how they show up in the world. No, I'm totally down with it. I just thought your example was funny, but it made sense with it with the hippie reference. Yeah, because that's also, ah you know, something I highly support is kind of comes from feminism. Right. Right. I'm not going to be constrained by this male, patriarchal culture. Exactly. Which people may, I'm often you know seen in that light because of my social identity is um you know like im a middle-aged man, basically. which is Which is okay. And so that might make that might mean something different or make you uncomfortable in a way that it really doesn't kind of affect me.
00:19:36
Speaker
The social identity is constraining. right So your identity as a therapist, right? We could talk about that, okay.
Navigating Ethical Boundaries in Therapy
00:19:43
Speaker
What do people think a therapist is supposed to be like? What is the cliche, the stereotype? What are the exaggerated expectations? And what are what are the sort of reasonable ones? And yeah what's behind the curtain? Like what are our professional obligations? sometimes therapists don't stick with their professional obligations, which by the way, vary from profession to profession. I was talking with a mixed group of so of therapists and were were you there? We were talking about like, oh, can you date patients?
00:20:15
Speaker
And for psychiatry, the the rule is never. Like it's written into the American Psychiatric Association's code of ethics. Once someone is a patient, you're really never supposed to have any other kind of relationship with them because you're supposed to always be available for them if they want to work with you in the future. For the American Psychological Association, by contrast, it's frowned upon, but there's a two-year statute of limitations. So after two years have elapsed elapsed, the ethical code allows for having outside relationships. Yeah, I have a lot of feelings about that. And I don't think having it as a forever thing is because we need to be available if they want to come back into treatment. and That's how I was taught. Right. But I think if there's some like really like erotic stuff happening or romantic feelings developing,
00:21:11
Speaker
that person, you know, they can find mental health treatment elsewhere. But I think that the issue is. That's a different issue, I think. Right, right. The issue is that it's a power imbalance and you know things about this person that they told, they really only told their therapist. right and so so one of So one of the concerns is that people may develop romantic feelings in the context of a caregiving relationship. And I think the archetypal example of that is, at least in my mind, the the stereotype is a male patient who falls in love with a female nurse.
00:21:50
Speaker
That's sort of where that comes from and there's something about being taken care of that can, you know, engender erotic feelings and so hence the boundaries. Yeah. And I realize that's like a heteronormative, you know, no no of course, but I think that can be recreated in a lot of different. situation when When you show a lot of care first for people, they they can start to feel a romantic attachment. And and that's normal. It happens. It's considered to be a normal part of therapy. And therapists, you you might say, not in a moralistic sense, but ought to know how to deal with that type of transfer. And not say, oh, I'm going to come back two years later and ask this person out, right?
00:22:34
Speaker
Well, or even even during the course of the therapy, you you gave an example of, well, if if that gets very strong and it it gets in the way of the therapy, you would have an obligation to say to that patient and to process it with them and not just to sort of, you know, sorry, I can't meet with you anymore, bye. That's kind of the same, some of the things we see as things that are icky. yeah um is when a therapist just stops therapy without much explanation and without helping the patient transition care. We have an obligation to help people transition. So the conversation would be, let's see if we can work through this yeah set of feelings that's coming up, because it may be therapeutic to work through it, but if it ends up being an obstacle to the treatment alliance, then I would work with you and help refer you to someone else to maintain the continuity of your care.
00:23:21
Speaker
yeah But we know that not all therapists practice that way. You and I are trained, you know, yeah first of all, as psychiatrists, and second of all, within ah a psychoanalytic model, there's boundary violations in psychoanalysis, but that's what you're supposed to do. You're supposed to work through it or help the patient move on. yeah And likewise, if you started having really strong feelings toward a patient, you might not disclose that to the patient necessarily, but you might tell them that there were reasons why you couldn't work with them anymore. Right. And I think disclosing that to a patient would be just unduly burdensome.
00:23:59
Speaker
you'd have to really think through whether the disclosure would be therapeutic or not. And in situations like that, the standard recommendation would be to seek consultation with a colleague who is skillful in helping to navigate boundary difficulties. yeah That's sort of by the book. Exactly. That's where you're like, Oh, Brenner is so stringent. Like I'm just, you know, I was trained traditionally. And I think there's usually good reasons for it as gratifying as it can be to kind of get your therapist anywhere, anytime and sort of feel that freedom. Like this is so new and different, you know, yeah that's a certain kind of idealizing experience. Right. And it's not something that most human beings can sustain, right? Because everybody's unavailable at one point or another. We all need sleep. We
Therapists' Guidance Amid Multiple Advice Sources
00:24:49
Speaker
all need downtime. We all need, yeah. So I think it's like, well, what are weetting what are we setting ourselves up for? But the last thing that I wanted to bring up, because it is something that's kind of hard for people to talk about, even though we talk about a lot of different things, is
00:25:08
Speaker
what other either therapists or coaches or astrologers like what people might say to our patients and how they bring it into therapy and sometimes their self-consciousness around what another therapist did that was good or bad. Well, past you know comparing to past therapists or wondering what it would be like to work with a different therapist, that's one thing, and and important to explore, and and patients should feel comfortable bringing those things up when I say should comfortable should feel comfortable, meaning that meaning that I have to respond in a way that is open about it. And then the other thing that I think you're referring to is sometimes called like shadow therapists. So are there are other people who have a therapeutic role? And there's a lot of um differences of opinion on that. um You know, some therapists might almost get jealous and be like, why are you talking about those things to someone else? I don't think that's right. um On the other hand, when you have actually multiple therapists, it can be very confusing for patients to kind of make sense of it. There is an idea that focusing the therapeutic process
00:26:18
Speaker
with with one particular person has more traction in some ways. Totally. But does it annoy you or make you jealous or make you angry? Or if i feel threatening in some way. Or feel threatening. I would say that most good therapists, if they're secure in their abilities and in their role, should be able to talk that stuff through. Yeah, I think that's right. But what if you hear some advice that someone is telling you they got from someone else and it's not like, you know, their're their doctor, like, you know, if if you're the psychiatrist, right, you work with a therapist and, you know, you you might be able to call up the therapist and say, I wanted to, you know, check in with you. So what if what if you hear someone got what you consider to be like really bad advice? Like someone was telling me that a therapist was advising a patient improperly about migraine medication.
00:27:13
Speaker
And, you know, they're not practicing within the scope of their license. You know, like a you know therapist who's not a physician can't really offer medical advice on treatment of migraines. Exactly. So I do think that that is a great opportunity, what you said, that they're outside the scope of their practice. That's actually a great opportunity to model good behavior, right? And to say, this person doesn't have a medical degree. and maybe trying to be helpful. I believe that that everyone who, let's say, steps outside the scope of their practice, that the reason they're doing that is because they they had their own experience or they want to share something or they want to be helpful. So the aim and the pull to be helpful to someone sometimes supersedes our ability to say, hey, you know what? I just don't know anything about that.
00:28:07
Speaker
Right, but but what do you do? Do you tell the person, you know, I don't agree with that advice or if they're actually a therapist, right? you can You can say, you know, I'd like to check in on that. I hear some very divisive responses to that question. Other people are like, report them to the board. No, no. What I usually say is, oh, I don't know that much about migraine medication because even though I went to medical school and I have a medical degree, my training is in psychiatry. And so if you have questions about your migraine medications, this is great. Let's find a specialist, right? Because it's not only, these are people who, you know, there are headache fellowships. We're a primary care doctor. Yeah, maybe a primary care doctor, but I guess my point is I won't comment on things that I don't know about, but I will say, well, let's figure out where we can get that information the same way. If someone were like, well, I want you to read tarot cards,
00:29:06
Speaker
That's outside the scope of my practice. I can't do that. I'm not going to learn to do that. And so if it's an important thing for somebody to have in their life, I'm kind of curious to hear, well, what did that mean for you? and but what if So what if they go to a tarot card reader? And and I think tarot is interesting, but I you know personally don't believe in and in any supernatural things. um But what if, as is often the case, you know a psychic or a tarot card reader or a physical therapist or a yoga person is essentially giving therapy advice and you start to feel that it might be interfering in some way.
00:29:45
Speaker
I would say I think this might be interfering with our treatment, but I would never, and this is like so important, I would never be mad at the patient. I would never feel annoyed at the patient and I would always be grateful that they're bringing it to me. Yeah, i I think when people want to get help in some way and then, you know, there's there's nuances to this. There may be situations where the person's judgment is impaired and that would be a different story or if they were being taken advantage of. Right, because that's the other thing that comes up where it's like, you know, we're very lucky that we have plenty of patients and we don't need to rope someone in to more treatment than is it is appropriate for them.
Creating a Safe Space for Patient Dialogues
00:30:30
Speaker
Well, there's a certain duty to protect. Right. And that's more that's more pronounced among physicians on average. Yeah. But I think that the fear and why this kind of thing might go underground is because people probably don't want to say, hey, my acupuncturist actually said something that was more valuable than anything you've ever said, and this here's what it was. But if it was important to them, I want to hear about it. And, you know, if I had an issue with another clinician or another person in that role,
00:31:01
Speaker
My only hope is, yes, they're bound by some code of contact conduct or they have some board, but I wouldn't necessarily go and report that person. but no No, nor would I. I agree with you. I think you want to create a safe space for dialogue where things can come up and not be defensive as a therapist and and be open you know to learning too and collaborating. That's generally how I work. But we're talking about the times where that stops working sort of like with, with the scheduling, like I like being flexible. I don't want to hold people to a standard that I can't uphold. Yeah. I get it that I'm, you know, that I'm being paid for a service though. So it's not exactly symmetrical, but there's a line where it can end up being problematic. And then you have to find a way to say something for patients. Maybe
Therapists Managing Personal Emotions
00:31:47
Speaker
the flip side is when people say like, they wonder how you feel about them in relation to your other patients. Hmm, that is a tough one. I think because so few people are in the role of actual therapist, right? But a lot of people may have a family with lots of different family members or a friend group, right? And so there are moments where we feel close to one person or close to another person. But I think the truth is that over time we find something different
00:32:23
Speaker
to love in each person so it's not like oh well everyone just gets a piece of the same pie it's like it's like cupcakes right and everybody has their own well you're like I love everyone the same just in different ways but then there's the idea like does a parent have a favorite kid and or to the the kids do they feel rival risk for the parents affection you know And in general, human beings, you know, there's some variation from person to person, but we need and want to be liked. And that's true for everyone, including therapists.
00:32:56
Speaker
But I think if patients feel like their therapist likes them too much, then it can be hard for them to share the uglier parts of themselves. Right. People ask you if, if you, if you kind of give them special treatment, like, Oh, are you, you always so flexible with scheduling or do you do this with all your patients? I mean, it hasn't it hasn't really come up, but i I do think that I try. I find myself having to hold back. You kind of make everyone feel like they're your favorite. Right, right but also?
00:33:33
Speaker
sometimes when I have very, very warm feelings towards someone, I actually have to hold them back because I don't want to put that on someone else like, oh, I'm so happy to see you. you know And they're like, oh my God, my therapist missed me so much. like That's not good for them. Therapist ought to be aware of kind of their caregiving tendencies and their attachment style right and all those things. But yeah but you know you have a way of really making people feel special. but that's because I value my time with each person and also because I'm really grateful and I feel, I guess, totally honored in some way that people are trusting me in that role. Privileged. Yeah,
When Should Therapy End?
00:34:16
Speaker
it is. I mean, being trusted with someone's
00:34:19
Speaker
you know But you can feel like honored and grateful and privileged to have that important role. And then, of course, there's a questionary note, which is, you know, therapists ought not to consider ourselves to be too important. Therapy ends and people move on. And the therapy relationship in in most cases is is meant to make itself obsolete if you're successful. So you need to be ready to kind of be left behind, like a transitional object, like a kid no longer needs a teddy bear. I know. And I do think that's one of the most beautiful parts of our work, but also it is kind of bittersweet because it's like this person is doing so much better and they don't really need me anymore. But that also means that I'm not going to see them every week.
00:35:07
Speaker
That's a sacrifice you make as, as a therapist, even if therapy sometimes takes many years to move, to move on. And there's another, there's another discussion, which we probably won't get into too much today about when can therapy be ongoing? When is that appropriate versus, you know, you finish. Right. And whether or not. it sort of is okay to reach out after the therapy is over. Now I think sometimes I have wondered, right? How are people doing? I would love to hear. Do you send customer satisfaction service periodically? I don't. I don't reach out. That's not what you're talking about. I'm kidding. I know, but I think it's hard, right? i I do. I wonder about the people who I don't see anymore, who I cared so much about.
00:35:55
Speaker
but You really like it if you get that holiday card or every once in a while I get a call from someone years later, I'm doing great or occasionally I didn't like what you did and I wanted to let you know and I'm always likem really glad you can say something. But the need to be liked though is quite different from feeling like it's an honor. Like you know anyone who needs to be liked too much in any situation practically can get into trouble. right right If you need to be liked too much as a therapist, it it may make it hard for you to say what needs to be said or to wonder about what needs to be wondered about. And if if you need to be liked too much as a patient, it might make you hard and make it hard for you to give feedback to your therapist.
00:36:36
Speaker
Exactly. That can be a deterrent. Yeah. And, you know, being attentive to that dynamic could be helpful. We're trying too hard. You know, I and i know I reference Freud a lot. I like want to assure people I know more than just Freud, but he he got a lot of things right though. And one of the things I'm thinking of, he cautioned in one of his very early what they call technical papers, like how to practice. He cautioned against what he called, it at least in German, the English translation is he cautioned against excessive therapeutic zeal, yeah AKA trying too hard to make things better, to fix things. to like Right. Right. Then that is something that I yeah struggled with. Right. But how so it's because it's
00:37:23
Speaker
hard I mean, today we brought we brought up a few things that actually people think might upset us, but for the most part really doesn't. But I think the thing is that do upset me as a therapist and kind of connecting to our last episode with Robin Stern, seeing people get mistreated or struggle or any sort of trauma, things that our patients go through that are difficult upset us too.
00:37:54
Speaker
And an inability or struggling to set boundaries or that kind of thing, it doesn't make us angry or annoyed, but it might affect us in ways that... you know Or you might feel annoyed and then you'd have to think about that and work with it. Right. right But I guess that's our job and that's what we sign up for. So we want to be there for that struggle, don't you? like wouldn't you rather be hearing about it and working on it and not. I mean, that's what you're supposed to do. So I can agree on that level. Yeah. Though I think as a psychoanalyst, another um prime directive is to always be open to possibilities. So if you say, well, if someone does something, I'm a therapist, I can't be annoyed. And I'll be like, well, yeah yeah I can be annoyed, but what I'm not supposed to do is I'm not supposed to play out that annoyance right the way I might in my private life.
00:38:53
Speaker
And in my private life, it may not be great to take play out that annoyance, you know, passive aggressively or or something. But as a therapist, we want to reflect on our actions and be thoughtful. And sort of the higher value is curiosity and exploration in the service of development and growth. yeah and and giving people a framework within which they have that room. And so it also does mean being open to all feelings. So I think if a therapist had a blind spot, like they didn't feel comfortable being annoyed, then then you know that would be something to like notice. And over the course of one's profession, you know there's ah one of the nice things about being a therapist is you're always learning about yourself.
00:39:36
Speaker
For sure, but I also think even with patients, you know, if you annoy or piss off your therapist, then they're still going to be there for you. So that is a really important message that no matter what happens, it's like, well, I'll see you next week. Yeah, that ought to be the case, right? And that's one of the ick factors is is if a therapist seems narcissistically vulnerable and you bring up a problem and they get defensive and they try to gaslight you and talk you out of it. One of the Reddit sub threads actually speaks to that point as maybe a nice way to start to wind down.
00:40:12
Speaker
yeah for today, though um'm I'm still thinking about this idea of needing to be liked to too much as just something, maybe that's our doorknob comment, you know what as we're walking out the door, I wonder sometimes if I need to be liked too much. I wonder if that gets in my way sometimes. But one of the threads was a patient described an interaction with their therapist where they were describing a problem they were having with their brother. And the therapist was like, I think, you know, I think you take it too hard and you know, you're, you're contributing to the issue and the patient's like, I really felt hurt, like of hurt. And it really stuck with me in a negative way. The next week I went into therapy and this is kind of has a happy ending.
00:40:57
Speaker
to your point, you know, there's a rupture and then a repair. The therapist brought it up right away and said, you know, I felt bad about what I said last week. I felt like I wasn't really hearing you. And I wanted to acknowledge that and and see where you were with it. yeah And so the idea is you really can't always be perfect, but you can be good enough. you know, that's from attachment theory and come back and say, I i think I made it a mistake or I think, you know, I think I didn't handle that as well as I wanted to. So i'm um I am left wondering about being liked, you know, being like too much and also not caring about being liked enough. Right, I guess both um can kind of set people up. But if you like the podcast, please leave a positive review and rate us. Because we really need it.
00:41:47
Speaker
really need some clicks. Um, okay. Well, thank you. Do you think I'm too dependent? Thank you. Do you think I'm too needy? You know, doorknob comment. Yeah. Yeah. That's a good question. Thanks for listening and you can find us online on Instagram. And if you like what we're doing, a rate review would be wonderful. Remember, the Doorknob Comments podcast is not medical advice. If you may be in need of professional assistance, please seek consultation without delay.