Positive Health Online

I was at a party last week, and sometime after a long conversation with a group of people, an unknown gentleman, well-dressed in a tweed jacket, broke in and suddenly inquired of me: "You're a doctor, what kind of doctor are you?" "I'm not a doctor," I said, "I'm a psychologist."

His attitude showed a sliver of contempt, but he condescended enough to state that he was a physician and doesn't think much of mental healers.

Well, what else can one expect? Some readers may know the old saying among medical men: the surgeon doesn't know anything but does everything, the pathologist knows everything and doesn't do anything (i.e. the patient is already deceased by that time), and the psychiatrist doesn't know anything and doesn't do anything!

Physicians in general look down on the practitioners of psychotherapy, although there are some exceptions. I have heard the term Soul Doctor applied to therapists by various tough-minded, biologically oriented practitioners of the art of medicine.

But the term need not be seen in a negative light. In fact, Viktor Frankl, the famous Austrian psychiatrist, wrote a well-known book, The Doctor and The Soul, first published in 1946 and still popular during the 1970s.

Yet we psychotherapists, for the most part, often get stamped with an inferior passport. After all, the physician has his trusty black bag, containing all sorts of instruments and technical aids to assist in healing the ills of mankind. The psychotherapist has only his ideas in his head. This is often not very impressive to outsiders.

In fact, how does one know that good is being accomplished? We don't observe the stoppage of a bleeding wound or anything of that nature.

And ever more so these days, the good doctor has his pills and potions! But the psychotherapist has nothing so dramatic to offer a patient in pain.

A dilemma for all psychotherapists is the vital question of are we doing any good? I recall a short story by Somerset Maugham about a psychiatrist who seemed to have no idea why his patients improved. It just happened, and he was completely lost for an explanation.

Was it his voice? His confident manner? Was it the simple ritual of the confessional that could (in Shakespeare's language) "pluck from the memory a rooted sorrow"?

Of course we know a little more today. Or at least we think we do. Sigmund Freud was well aware that at times the 'cure' was due to the patient's love for the analyst – he called that positive transference. However, such instant solutions were considered temporary and not to be taken seriously. In the beginning phase of therapy, there is frequently the 'honeymoon effect' which peps up the patient so that the world is good again. This does not last. Soon enough comes the after-effect: the negative transference with the hostility towards the therapist and the treatment. Too often, in fact, one gets the negative transference without the benevolent.

One often sees this quite clearly in the case of patients who are initially too positive to their therapy. They have great expectations for instant cure, which of course no mortal can live up to. So after the early period of sheer positive glow, there comes soon enough the backlash of recriminations, critique, etc.

The best patients are often those who exhibit a healthy scepticism at the beginning of therapy. Later, they may gradually, step by step, show cooperation and increments of personal growth. We don't plan for the instant cure; therapy is a rather slow learning process, a kind of "education of the emotions" in the words of one psychotherapist.

So, beware of those ultra-enthusiasts, the 'true believers' among your clientele; they are often the most recalcitrant in the long run.

Of course, one never knows precisely why one particular patient will improve remarkably, and another, perhaps even more talented and with fine prospects, fails to achieve any personal growth. It is one of the great mysteries of this work.

Let me give an example of one case where it was, in fact, rapid and apparent what was going on. A colleague called me one day to ask if I could take a case of a young woman; "very dangerous and suicidal" warned my colleague. I met her soon after; she was 24, depressed, a somewhat shy girl from a small town who had moved to the capital about two years ago from her secure parental home. I asked her what her problem was – briefly, she was extremely depressed because she had been sacked from her job six months earlier. What kind of job? Working in a bank. I asked if she had liked the job? She replied in the negative, so I continued with "Why did you take a job that you didn't care for?" Her mother had told her to seek a secure bank position. I then asked her bluntly:

"Do you always have to do everything your mother tells you?" I saw a quick change in her face. Her eyes woke up, burning.

Apparently, I was the first person of authority who informed her that she didn't have to always follow mother's guidance. It was an 'awakening'. She had always been a nice girl, well brought up, and obedient to her family.

I asked her what kind of job she would like to have, and she responded at once – working with children. I never saw her after that one session; we spoke on the telephone once, and she said that she had a new job working in a day nursery and felt quite satisfied. Now, if I had dug into her past and explored problems with 'authority figures' such as her boss at the bank, she would have remained in her depression for a long time. But here was one lucky example of how a bit of 'reframing' can have a fast effect.

Obviously, few cases show clearly such fast results as the example I have just outlined. In fact, more often, things are unfortunately considerably more complicated and obtuse. Yet we work on in the salt mines, as a colleague used to say, using what limited tools we possess.

Richard Kitzler, a senior member of the New York Institute for Gestalt Therapy, used to warn young therapists of their tendency for therapeutic exuberance. Keep in mind the limitations of our knowledge and ability. Perhaps what psychotherapists need most of all is more humility to balance (in Kitzler's words) "the arrogance that we can make a difference in their lives."