“My therapist announced to my group that she plans to be out for ‘several weeks.’ Uh oh. What does she mean by ‘several?’ I know she hasn’t been feeling well. And she’s never taken off more than a week or two. This seems ominous. I look up ‘several’ on my Apple watch, but it’s inconclusive: More than two, but less than many. How much more than two, I wonder? This is making me even more anxious. I don’t think I can make it to group tonight.”
Upon returning from a vacation I heard about this conversation between one of my patients and her Apple watch. Humorous for sure, but her anxiety was a serious matter. I began to think about whether or not I had in some way participated in creating her dilemma. I understood the basics of it. She missed her therapist. She missed the weekly activity of being with the person who she feels knows her, understands her and most importantly, can help disentangle her often puzzling emotional ups-and-downs. Her therapist is the person who, no matter what craziness goes on, has the societal imprimatur to jump-start her journey of seeing/creating life’s possibilities. I left for several weeks’ vacation. And in that time, where did she go?
Rested from my time away, I had the space to take a fresh look at this somewhat strange form of life called therapy. What is the nature of the relationship between the therapist and the patient and between therapist and group? Throughout history, there have been all sorts of characterizations of the therapeutic relationship – everything from Freudian psychoanalytic accounts to postmodern deconstructions. Some of the latter have identified and then attempted to abolish the “authority of the chair.” Yet that authority lives on. I asked myself whether I inadvertently had something to do with my client‘s insecurity and anxiety in my absence? I did not think that I personally or intentionally created this dynamic. However, I wondered what role the institution of psychotherapy might be playing here.
What came to mind was the standard cartoon characterization of the therapy session: The patient lies on the couch (passively), while the therapist (actively) scribbles their thoughts and interpretations about what the patient is saying. Whether we call our work “collaborative,” “narrative” or “community-based,” to the extent that we are captured by this picture of therapy, aren’t we at least in some ways participating in the myth that (essentially passive, helpless) adults do not have the wherewithal to create their lives (including their summers)?
I thought about the social /cultural organization of psychology itself and how it hovers over therapists like a cloud. Was it raining its influence on me in some curious way I was unaware of? I began to take a harder look at what I believe is the more insidious side of the therapeutic relationship. Do we not (despite our best intentions) relate to our patients as if they cannot grow without us? Do we leave them out as primary partners in our therapeutic collaboration?
I believe that if we are honest with ourselves, the answer is yes. The myth of the therapist as knower, full of insight and solutions, lives on. Being the knower implies authority – that one is in charge. Posturing as the knower, therapists can relate to patients as the consumers of their insight.
In these post-vacation weeks, I’m more concerned than ever with how to remain vigilant against this stultifying mythology surrounding “therapist” and “patient.” I’m raising philosophical questions with my groups about our process and our relationship: What are we doing together? Who are we to each other? Are we accountable for what and how we are building together? Can we get better at a continuous process of exploring who and what we’re becoming, rather than laying blame and offering explanations for why we are who we are?
I’m happy to be back doing social therapy. We’re making good use of the issues raised by my taking a vacation. And my dear patient with her Apple watch in tow has come back to help us.
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