Thursday, June 21, 2012

First Contact/ First Visit

I thought I had already blogged about this but couldn't be sure, so I went to the Blogger search feature and entered first visit to bring up my many posts and drafts. So much popped up I almost packed it in, headed for the kitchen to rummage the fridge. Almost.

So many posts! How did my friends (what's wrong with a liberal definition of that word?) ever get through them? As I once told Jack, author of Random Thoughts: Do They Have Meaning, there are hundreds of drafts hidden in the Blogger dashboard. But I'm given to hyperbole, so he didn't believe me.

Is this a manic symptom? It could be, but it isn't for most of us. How much we write, if not how well, reflects personality, a need to communicate, to socialize, maybe verbal aptitude. Having a lot of words, needing to express them, some of us do it this way. People who don't know that we write might even think we're quiet, because some of us are. If we engage in this consistently enough, it might be fair to say we are writers. For anonymous writers this is a hidden aspect of personality, not one that is necessarily noticed or known in our ecosystem, our world outside the Internet. But it is personality, none the less, an aspect of identity, a way of expression.

Therapists with too many words are likely to be vocationally frustrated. We aren't hired to talk, we're hired to listen. We have to let you talk, even encourage you to talk (Tell me!), make it safe for that to happen. You're paying for this, after all. The wonderful thing is that our restraint factors into a more focused, clearer summary. We say things in fewer words, make an impact with less energy.

I'll often ask, after a short, tentative interpretation of someone's words, "Does what I just said ring true to you?" The patient might ask for more, more words, which is a trap, gives me license to embellish, to talk a lot more than I should.

It isn't always obvious when the patient is checking out, uninterested, even upset that she has lost the floor. So even then, even when asked to explain, the therapist had best reflect the question back to the patient. "No, tell me what you think. It doesn't matter what I think."

See, even when we have the license to talk, we have to control it, perhaps the hardest thing ever, for some of us, not only as mental health professionals, but as people.

A blog is a license to print, and as my rabbi likes to say, we should print wisely, or not at all. This is just like in therapy! The therapist should speak wisely, or not at all. Both venues, therapy, blogging, lend themselves to open spaces, opportunities to fill the silence when perhaps the silence shouldn't be anything but that, silence.

In a couples therapy, when people argue in the name of problem solving, it can get destructive, so we ask people to rethink what they're saying, to edit their words. It isn't exactly like talking to bickering grandsons at the Target prescription counter. "If you have nothing nice to say, don't say anything at all." A white haired customer, overhearing this will smile, and even more remarkably, children quiet down. But we can't do that in therapy. There has to be a covert or an overt rule that nobody gets hurt here. Not in my office, I say.

The trick, of course, is not to shut anyone down. Therapy is about opening people up, getting to core issues. It happens when we resist the temptation to share our opinions, to probe, and certainly, to explain.

Here's an old draft. I'm pretty sure I never posted it, but I'm not sure what's out there anymore.


Sounds like the title of a Star Trek episode.

We talk here on the blog about couples therapy, family therapy, even healing an ailing institutional setting. But a good individual therapy is golden, with a focus on the patient, the individual alone. Individual therapy is still the a Cadillac, if not the Rolls Royce, of treatment.

Even systems therapies (definitely the Rolls), attract empathetic therapists who sense when someone needs to talk alone, free of interruptions, reactions of other people. We try to oblige, and it isn't always easy extricating the needy individual from a significant other or parent to work alone for awhile, not lose the one left behind in the process.

When it is an individual therapy from the get go, it is because someone determined that therapy is not a luxury but a necessity. That, or a respected someone suggests a professional. Being social animals, socially influenced, feeling awful but open to change, we pop for it, we make that call for help, especially if there's insurance to rely upon, some other way to pay than robbing our ever-diminishing nest eggs.

First contact, the therapist is listening, feeling for what is wrong. Sometimes the quiver of a voice tells us much about the person on the other end of the line. We’re drawn in, want to alleviate the anxiety right away; this is our territory, calm and empathy, and it is natural for us to give it our best to get shy, reluctant patients into our offices. We hope they will make that first appointment, we know that someone has whittled them down, robbed them of that feel good, and we want to help make it right.

Because the prevalence of psychiatric disorders is on the rise, has been for twenty years, more people than ever are calling. Thanks to the Internet, digital marketing, Psychology Today, and a steady stream of variants on Dr. Phil, everyone is therapy-wise, sophisticated. Some still call with trepidation and unconditional respect. But most sound savvy, with expectations, and this isn't good or bad, it just is.

Empowered, help-seekers catch us on the phone and ask if we wouldn’t mind answering a few questions. Or we get email, voice mail asking for a couple of minutes of our time. We are interviewed by prospective patients who sound confident, wise about preferred treatment solutions, needing certainty we will provide.

Everyone wants a good fit, something that systems therapists think is fabulous, of course.

Some busy therapists don't want to be interviewed, don't have as many words to spare, maybe, and aren't actively seeking work. Most of us don’t have a receptionist, either, to field our calls, to go through our email. (The job doesn’t pay that well.) If we answer the phone, sometimes we're caught in an interview against our will, depending how much we enjoy being grilled while people wait for us in the waiting room.

The first visit really begins right there, engaging, reaching someone we may never see, someone who may choose not to use us as their therapist.

Or perhaps we will agree that the time "wasted" is part of a process, what we do in life anyway, have conversations that will go nowhere. And surely, even when it is only a telephone interview, what a therapist tells a prospective patient might be repeated, somewhere, somehow, to someone.

So yes, it goes without question, Rabbi. What we say, no matter where we say it, even at that first, invisible contact, had better be nice.



vicariousrising said...

This is a really good post. I've been through probably a dozen therapists if you include the ones in rehab, and that first visit is really important in setting up the relationship. And the less in touch with myself I was, the harder it was for me to gauge whether a therapist was a good fit. Early on, I was so reliant on the therapist's expertise that I would ignore my gut feeling that things weren't working for me. But I would quickly find myself making excuses to not go to therapy. Then again, when therapy got difficult, I'd run away too. The difference was that even after I bolted, if the therapist was good, I would make my way back before too long.

I'm sure my comment is completely unhelpful. Maybe a summary of my experience with therapy was not only interviewing the therapists but also learning to trust myself while doing so.

therapydoc said...

This is a great comment. Are you kidding me VR, that it wouldn't be helpful? In my experience, your experience is very common. I ask people about their experiences with therapists, these kinds of processes, yin yangs of the therapeutic relationship. I helps me help them. Thanks so much for taking the time.