Sustaining Therapist Hope
April 23rd, 2011 adminI’ve missed blogging with my friends and colleagues! Check out the video on the sidebar and remember that I love your questions and feedback. My new highly experiential, extended workshop for therapists, with clinical video illustrations, “Intensifying Deep Affective Processing” will be held on 5 Saturdays, 11:00 – 4:00 P.M., on August 13, Sept. 10th, Oct. 15th and Nov 12, and Jan. 14, 2012 with lunch and materials included. It’s been a terrific experience to have co-led a similar workshop with a highly motivated group of therapists with the superb Thomas Brod, MD. The new series will have a heavier emphasis on the experiential component. My intention is to devote significantly more time to role playing practice of specific interventions for different phases of treatment with a broad spectrum of psychoneurotic disorders. Please email me right away at swarshow@me.com or call 818-378-1418 to tell me of your commitment so that I can confirm the beautiful Skirball Cultural Center in L.A. for our location. The fee is $850. before May 27, 2011 and $1000. thereafter. More details to follow shortly on my website, www.warrenwarshow.com.
You’re invited to join my Monthly Mondays supervision/teaching group, which offers engaging experiential opportunities to learn the art and skill of reaching and processing deep affect. We’d welcome new members. Call Susan at 818-703-1145 for more information.
Don’t forget another terrific training opportunity with Jon Frederickson, MSW, and myself at the beautiful Graves Mountain Lodge in Syria, VA, on June 5-10, 2011 for the Washington School of Psychiatry’s 6th Annual Summer Immersion Course.
I will be speaking on “Awakening Hope to Defeat Resistance.” It’s been fascinating to reflect on the importance of therapist hope within the therapeutic dyad. We tend to focus on the client’s sense of hopefulness but not our own. We’re told to stay hopeful and to project hopefulness, but we are not told how to do this. I’ve been recently challenged myself when it seemed that no intervention was working and the client raged, “OK, I know I’m self-destructive and I know I act out, and I know I push people away, and I know that I’m anxious but so what that I know that? I make some progress and then I slide back and here I am out of control again! And I know what I need to do but I don’t do it!” Perhaps the patient adds, implicitly or explicitly, “And it’s your fault!” It’s especially delicious when the client projects all responsibility for the setbacks on the failures of the (dare I say beleaguered) therapist and refuses to stop ventilating and discharging and projecting and abandons all self-reflective capacity.There may have been a medication reaction exacerbating this particular client’s outbursts and curiously, he also reported having new recent successes. (Uh Oh, I just remembered that perhaps his relapse in session was DUE to perpetrator activity BECAUSE of the recent successes)!
Yes indeed, there are times when we lose hope…for all sorts of reasons. So, how do we sustain our sense of hope after a discouraging session or a treatment failure? And by the way, if anyone ever says they don’t have treatment failures, be very suspicious! I remember a great article in the Psychotherapy Networker magazine in which the author (don’t remember his name), an accomplished therapist, did research on his treatment outcomes and was amazed that some patients, whom he thought had positive reactions, in fact had not. And others, whom he thought did not respond positively, actually had! Also, his perceptions of what had occurred in session often did not match the patient’s! We also know of seemingly “successful” treatments in which the patient sought another therapist eventually or whose problems reoccurred.
At discouraging times, what can we do to sustain our sense of hope? We do need to remember, always, that a successful treatment takes two to tango. The client simply must have enough will, self-care and self-reflective capacity to actively engage in the treatment process. Yes, it is our role to attempt to mobilize these healthy forces within the patient, but we absolutely cannot do it singlehandedly. We also must be compassionate towards our own vulnerabilities and missteps. Don’t we all sometimes wish we’d selected a few phrases differently? Or maybe we mishandled a new skill we’re just getting the hang of? Sometimes a client just won’t make room for our attempts at repair and the forces of self-sabotage are too great. But will we be forgiving within ourselves? Or maybe a particular dyad simply is a misfit…who can be right for everyone? Will we allow for these personal limitations?
Self-compassion sustains my own sense of hope, and I sometimes need reinforcement from others to reconnect with that. I also need to be selective with the clients I work with as I must be with other relationships. A sense of progress in treatment is necessary for me to keep the hope flame burning within myself. It also helps me to remember the successful treatments in my practice, past and present, as well as the successful aspects of a very frustrating case. Sometimes we forget that even bad experiences can still contain good parts. Wonder if anyone has studied a patient’s positive memories or outcomes related to a disappointing therapy? Many patients who come to me, having been in therapy with someone else, will still tell me of important progress they made with that therapist. Rarely is it black and white, if we’re honest.
I wish you a very Happy Easter and Passover.’Til next time!
