Using What You've Got

I think I've told you that a systems therapist, someone who uses family, significant others, employers, teachers, and cats, a systems therapist will use everything and anything to make a point. And sometimes the patient will literally hand over the material.

Here's what happened last week. Remember: I'm changing details for you. I'll say, for example, that the story happened last week, but it didn't. SHE could be a HE. HE could be a truck. No, that wouldn't make much sense, would it. But let's talk.

You may know that it's Chanucha. This is an 8 day festival. There are many interesting lovely things about the holiday, but for me it's about being home, lighting candles, and making sure the house doesn't burn down. Each of us in our family has an oil (olive) burning menorah. We have visitors from out of town this week, making that doubly important, not burning down the house.

It's the evenings that are important in this holiday, and most of us don't like leaving our comfort zone. We stay home at night, but work during the day. I try to get home a little earlier. I try not to schedule new patients who may or may not show, may not call. I try to be especially forgiving when patients cancel last minute. I try to stay in the holiday spirit because I know how stressed everyone else is in general. Merely trying to get it together or keep it together is very hard.

It's no small thing to say that it would be nice if everyone tried to stay in the holiday spirit always. But this is impossible. Even trying is impossible. (Is it?)

Somehow, the week before last, when I scheduled an appointment for last week, but made a mistake. The appointment didn't get saved on Outlook. Obviously it was me who didn't save it, since I make all of my appointments. This probably happens once or twice a year, me completely blowing an appointment. Yes, therapists are people, too, very fallible. It is possible that we can completely screw up, try as we will not to make mistakes. In this case, I'm guessing, I entered the appointment in the calendar and did not push Save and Close.

Save and Close is PRETTY IMPORTANT.

But I didn't know it and was in a pretty fine mood starting work on Thursday only to hear a VERY upset voice on voice mail.

Therapydoc! Where were you! I had an appointment at (such and such a time) and you were nowhere to be seen. Why wasn't I informed? Why didn't you call me if you knew you weren't going to be there? I brought (so and so).

I was looking forward to doing great work today. I'm so upset. I can't begin to tell you how upset I am. This is so unprofessional. What kind of doctor are you?@!

We're in the Being Late territory we've discussed before. **

I don't know about you, but I get a message like that and my chest clutches and I feel simply terrible. I call the patient right away, apologize, offer a next day appointment, meaning, in this case, that someone else will make an airport run, not me. I feel cornered, embarrassed. I say, The rule is in this case that I forgive your co-payment tomorrow.

She sounds quite fine with that.

Then, since I've got a few minutes before my first patient walks in, I look at her chart. I've only seen her once before. I have scrawled across the top of the page, Has assertiveness issues.

Would you agree?

Thus this is a good place to teach you how to use that sort of systems event in therapy. But understand. What a therapist really wants to say when the patient has Let it Fly on voicemail, is, Find someone you like better, someone who will do a better job. Someone who will never ever make a mistake. A better match. Seriously. In our heads we're thinking all kinds of edgy things, basically trying to make ourselves feel better for being slugs and making mistakes. But being a professional is not about doing that, taking our own error and turning it into the patient's fault.

The next day the patient comes in with her S-O and I'm on her team, of course, since I totally do want to tackle that relationship; I really do. To me it's all about everybody getting better, the challenge of it all. I want her needs met and I'm quite sure the direction we're going in is just right for the two of them, for him, also. The therapy flows very naturally and she's pretty happy that I'm getting him to talk about some of the things that bother him, approaching his issues, too, and for sure it's pretty easy to see where each of them is coming from and we're confident about making changes. Then at some magnificent point she really rails into him about something*.

He looks at me, stunned. She looks at me. I smile. I thought you said you had assertiveness issues, I say.

She smiles. I'm getting better already.

Oh, how I love people.

Copyright 2007, therapydoc

*Having assertiveness issues generally means a person doesn't speak up enough. But while working on it, I'll ask them to overshoot, to try for aggression even. Usually, that means they'll fail and the communication will come out just right. A passive overshoot becomes an assertive statement. If it becomes a rant, and it seems a little aggressive, THAT we can tone down relatively easily.

**This would be a good time to read that post on Being Late, if you like this sort of thing.