Wednesday, November 09, 2011

All About Me!

Psychotherapy is, by it's nature, a narcissistic endeavor.  That's not to say that the patient is a narcissist, but the journey itself is meant to focus on patient's interior life, and it's not always about the greater good.  In my last post, several commenters said they feel uncomfortable talking about themselves or worry that their therapist will mistakenly think they are narcissistic because they that talk about themselves in therapy.  

It's not at all unusual for people to express some discomfort about talking about themselves in therapy, or to comment, "all I do in here is complain,"  or "You must get tired of hearing people complain/talk about their problems, etc...."  

I won't talk for other psychotherapists because I only know how I feel.  It seems to me that the mandate of therapy is for the patient to talk about the things they have been thinking about.  The truth is that most people think about themselves and issues of the world are interpreted by individuals as they impact them.  Some people have lives that are very much focused around their immediate circle of events, the pain of their emotions, the distress of interactions with family, neighbors, friends, and co-workers.  Others may spend time discussing how the people around them are behaving in unproductive ways, and some people focus on their concerns about broader political issues that are important to them.  Most people don't come to spend their entire psychotherapy sessions discussing world events,  problems in developing nations, the European economy, climactic issues in other parts of the country, or other world events unless these things directly impact them, or they are things they are spending a lot of time thinking about.  

I like hearing about people's problems.  I may empathize or sympathize or say things I hope will provide some sense of support, or perhaps offe an interpretation that will give the issue a broader meaning in the context of the patient's life, but I don't generally feel burdened by other people's problem.  I am too busy feeling burdened by my own problems, and for the sake of my job, I get the luxury of being able to turn off my own problems and focus on someone else's internal world for 50 minutes out of the hour.  I like this and I get paid for it. 

Do I ever think a patient is narcissistic?  Well sure, if they tell story after story where they seem completely unable to see that another person might have a different point of view, or repeatedly recount events where they've behaved with complete disregard for the feelings of others or respect for the law.  For most of the people, most of the time, I think they're just people who come to therapy and they talk about themselves because that's what therapy is about.  Am I bored?  No.  Do I ever wish a session would end and I could finish the day and go home and change out of work clothes and chill out and think about my own stuff?  Yes, but that doesn't mean I find my patients boring, or that I don't care about them, or that I don't like listening , or that I don't like them.  I think it means that sometimes I'm human.

Mostly, I listen and try to be helpful.  I don't spend a lot of time judging.  (I can't say never because I'm a human being and human beings sometimes judge each other and you may think a psychiatrist should never do that but do write me when you've examined the content's of someone's heart and you've found the perfect non-judgmental person; I would like to have coffee with them.)

If you're worried that you're psychiatrist thinks you're too self-involved because you talk about yourself in therapy, you might want to find something else to worry about.  ;- )  (Roy will be back soon to translate my emoticons). 

And just a quick fyi: the definition of narcissism per wikipedia:
Narcissism is a term with a wide range of meanings, depending on whether it is used to describe a central concept of psychoanalytic theory, a mental illness, a social or cultural problem, or simply a personality trait. Except in the sense of primary narcissism or healthy self-love, "narcissism" usually is used to describe some kind of problem in a person or group's relationships with self and others. In everyday speech, "narcissism" often means inflated self-importance, egotism, vanity, conceit, or simple selfishness. Applied to a social group, it is sometimes used to denote elitism or an indifference to the plight of others. In psychology, the term is used to describe both normal self-love and unhealthy self-absorption due to a disturbance in the sense of self.