Sunday, December 09, 2007

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.

10 comments:

Barbara Kivowitz said...

How important that you took responsibility for your error and apologized. That alone is a powerful intervention.

When I was in my 20's and very therapist-unsavvy, I had a somewhat twisted therapist who didn't show for two separate appointments. Her way of dealing with this was to ask me what I might done to provoke this behavior on her part.

therapydoc said...

For everyone's benefit, I spelled Chanuka totally wrong. I'm in Big Trouble for this. I don't know why I did it. It's not a passive-aggressive thing. Now I have to correct every post. As Steve Martin used to say, Excuuuuse me!

Crabby McSlacker said...

Barbara, that's awful! I hate to hear stuff like that, and I get the feeling there are far too many therapists who won't take responsibility for their own errors and totally misuse their power in the relationship.

When I used to see clients (I'm a former MFT), many of them would seem totally shocked when I'd admit even the simplest of errors--that I may have misunderstood what they meant, or that I'd forgotten something we'd previously talked about that I should have remembered. The cool thing was that the recognition of my blunder and the emotional impact it had on the client often made for really powerful sessions. To be hurt, (slightly), by your therapist and to be able to talk about it is a great opportunity to explore how you deal with emotional pain. But that opportunity is lost if the therapist is more concerned with deflecting blame than exploring the impact of the pain they caused.

(And I was more cognitive behavioral than anything else!)

Very interesting post.

therapydoc said...

And here I can't relate to NOT owning it. I'll own it even if it isn't mine, just so somebody else feels better, which is silly, no?

With many exceptions. We'll get to those.

The challenging moments are when it's pretty clear that the date or time that I put on the card has been altered. I'll keep that information to myself for awhile, wait for a good time to talk about changing reality to fit with what we need. But I pocket the card.

chanasarah said...

OK.

1) "holiday spirit"... old tape! old tape! I could have dispensed with those two words a couple decades ago, tyvm...

2) Barbara - I am so sorry for laughing... (I don't cut my therapist a bit of slack, LOL) "Actually, I snuck into your bedroom in the middle of the night and turned your alarm clock off! What? Oh, it just means I'm a smart @$$ and I'm not letting you blame your irresponsibility on me!"

3)TD: There are like 37 ways to spell חֲנוּכָּה in English since it is by necessity phonetically transliterated so cut yourSELF some slack ;)

therapydoc said...

I so love it that you guys can zero in on my issues. :)

BipolarLawyerCook said...

Sounds like your work there is done. : )

chana said...

I used to drey my therapist incessantly for not wearing his seat belt. I stomped that boundary into oblivion! "Aren't you supposed to be modeling the kind of behavior you'd encourage in your clients?" (death stare) "We're all human and imperfect." LOL.

The good news is, I am definitely getting better in therapy. The assertiveness thing is coming along, LOL!

Blancodeviosa said...

That Save and Close thing always eludes me.

It's tricky stuff.

Jack's Shack said...

HE could be a truck.

Wasn't there a television series where "Mom" came back as a truck.