i-you-us

in psychotherapy, as in everyday life, the therapist can focus at any time on one of 3 arenas: the self, the other, and the relationship. yet, when i listen to residents, in supervision or in the classroom, speaking of their session, i hear mostly about the patient. he said this; she felt that; what's his diagnosis? what are her goals? certainly, the therapy is for the benefit of the patient. of course. but if the therapy is exploratory, if we are discovering together, the data is not just in the patient. what will she think next or feel next? i just remembered a dream; i'm singing a song to myself. we're ships passing in the night.

should my experience be discarded in order to stay with the patient? well, sometimes: if i enter the room thinking about my taxes and 15 minutes into the session, i think again about my taxes, i'd guess that these thoughts don't come from the session. but if i feel sad in the session, particulary, if the mood surprises me because i wasn't sad before the session, then my first guess is that the sadness is coming up in the exploration, is relevant, and should likely be included in the discussion.

most often i present my feelings as my own: "i just got sad," rather than "that's a sad story you're telling"; though, of course, i may say, "i'm feeling angry as you tell me what happened. you don't look or sound angry; is it just me or am i picking up on something that's in you too?"

looked at another way, at times what i experience is you-look-sad. at other times, what i experience is i-feel-sad listening. i think both experiences are legitimate, and i look for language to describe the first in the you and the latter in the i.

since i want to affirm a patient's perceptiveness, if she says to me, you look tired, i rarely give the stereotyped "therapist" response of "why are you interested in that?" rather, i look in myself to see if i notice the tiredness; and then, depending on what i find, say either, "yes, i guess i am" or "no, i don't think so; what are you seeing? (or give me a mirror).

i want to model for my patient a protocol she can use with their friends and loved ones. she can say, "i want more attention" or she can say, "i want you to do half of the housework." the first speaks effectively as an i; the second speaks effectively to the you.

what doesn't work well is mis-labeling the locus: the resident comes in and says, "that patient was criticizing me left and right today; she must be borderline." i have a hunch that focusing on the i of the therapist will likely be more genuine and more productive than focusing on the you of the patient. so i offer, "well, maybe, but what was it like for you taking all that? makes me mad on your behalf. did it make you mad?"

then there's the we. sometimes what i sense most strongly isn't in the patient or in myself; it's a quality of the relationship. we're bickering today, or we're not on the same page, or you're-doing-all-the-talking-and-there's-no-room-for-me-to-say-anything. so i don't say, "you're bickering" or "i'm bickering"; i say, "we're bickering." or i say, "can we do a better job collaborating?" sometimes i've even said, 'there's no 'we' today; can we get the 'we' back?"

Comments

[Marsha]

A colleague once said to me, "all that fuss about something so small." "We" the concept, the experience, is the prize, the treasure and really worth all the fuss. The content in psychotherapy is often suggested by the patient who may also bring quite a bit of insight to the table. The new awareness created when insight is shared with and cultivated by the seasoned therapist,is the "we." The creative space opens the relationship and the relationship makes more creative space. "We both smiled..."we danced for hours..." the rewards are definitely worth the fuss.