Tuesday, September 26, 2006

Please Understand

[posted by dinah]

If you read Richard Friedman's article Empathy and Understanding Aren't Enough in today's New York Times, you said to yourself, "Shrink Rap's gonna be all over this one."

Dr. Friedman writes:

I could already sense trouble. After six years of insight-oriented therapy, this patient had little sense of his own role in his unhappiness or what to do to turn his life around.

Next, I tried something a little more challenging: “I don’t get a sense from what you’ve told me that you feel responsible yourself to do anything to improve your life.”

With this, he sat bolt upright in the chair, crossed his arms and replied icily: “I’ve been working very hard all these years in therapy. You have no right to say that. You hardly know me.”

He had been working very hard all right — to maintain his status as a victim of a troubled history. And this was something he was loath to surrender. He clung to the notion that he was unhappy because he had been mistreated by various figures in his life: his parents, his teachers and disloyal friends, among others.

Dr. Friedman goes on to tell us that he helped this patient by telling him to grow up and get a job.

So I treat this patient as well as a few of his clones. The problem of being a victim and using this status to justify dysfunction is not uncommon, though I would argue with Dr. Friedman that it's hard not to sympathize with someone who has had a miserable childhood. Why some people move on and others stay stuck is as perplexing as why some folks have one reaction to a medication and others don't.

In past posts, I've made the comment that psychotherapy is a safe place for a patient to hear difficult things. So, I like the premise of Dr. Friedman's article though it's never been my experience that psychotherapy is simply about validating suffering and colluding with dysfunction; only a lousy therapist would do this. The role of empathy and understanding, however, is in itself often comforting and healing, and at the minimum, it supports the therapeutic alliance. The part I find hard to buy is that so soon (?the first session), Dr. Friedman took a patient who didn't particularly like him and yet was so quickly able to fix him without the backdrop of empathy.

No one listens to me like this.