Monday, June 08, 2015

The Therapist Takes a Vacation and Blurting: Six ways therapists can recover from mistakes

We all do it once in awhile, say something we wish we could take back.
You may not even notice when your therapist does it, might not even get it, but she does.
Mount Kilimanjaro

You likely will notice! And when you do, might be tempted to confront, and you might just do that. But this is a hierarchical relationship, despite all our talk about Empowerment Therapy and Call me by my first name. We come to rely upon our therapists, don't get excited at the notion of arguing or challenging them. Well, some do.

Which is fine!

But we therapists know when it's a blurt, a wish I could'a taken that one back moment, either by the look on your face, or through the words that play later on in our heads. (Many of us do this, think about you when you're gone, try to capture answers by reviewing what happened in the room.)

If we think we've erred, and shouldn't have said what we've said, we have options, some more mature than others, some more therapeutic than others. Let's start with five of them.

(1) We can wait to see what happens. If the patient hasn't questioned us and didn't look confused or upset, we might totally get let it die.

(2) Alternatively, we might call the patient a few days after, ask if she's okay, suggest that some of what was discussed last visit might have been disturbing. If we're confronted here, we have the option of explaining ourselves. Best to have the explanation ready.

(3) We might do an honest assessment to determine what possessed us to say whatever it is we said. This might take a few days, but the explanation will likely be better, and more true, with a few days hindsight. At some point the data will come in handy.

(4) We can call a consultant and discuss what happened to get another spin on it, get it off our chests.

Whether we think it through ourselves or with a colleague, it is safe to say that we don't just blurt things. There are reasons for what comes out of our mouths, and these are systemic, not all about us. The patient is driving what happens, the therapist is the passenger, occasionally sharing directions.

(5) We can decide not to decide, to wait and see where the patient is next visit. We might bring it up then, at the right moment, explanation in hand.

Let's take a quick example.

A patient of means travels often, talks about his vacations as they affect his family dynamics, mostly. But there is always a reference to the beach, and to the food. The therapist is not of means and does not travel much, but one day has an opportunity to do so, go someplace exotic.

When she cancels for the week she'll be gone, the patient gingerly asks, "So where are you going?"

The therapist tells him, straight out. The patient seems uncomfortable.

This is not a good sign. It means that the tell is a blurt, a blooper; the discussion of the therapist's vacation not the best move.

Why? He could have grimaced because he realized he had to drive car pool the next day, or something else. We can't assume, that, however because of these four unspoken laws.

(a) There is an unspoken (covert) rule that it is okay for the patient to leave the therapist, naturally, whenever he wants. But it is not okay for us to leave them. This feels like abandonment, especially if the therapist is going far away. (When I took two weeks to go to Israel a few years ago, a patient did land in a hospital. Nothing to do with me being gone, she said. Of course.)

(b) Does anyone really need to be thinking of their therapist in any other context other than in that chair, facing someone else's chair, listening intently with concern? Probably not.

(c) The less we talk about ourselves, the more the person who is paying for the visit talks about themselves, which is how it should be. Yes, even as they are walking out the door, it is about them.

(d) If an absence must be discussed, and sometimes it should be, then it is the patient's feelings that matter, not the details of the therapist's time off. When the patient asks, "So, where are you going?" the more relevant response is, "What kind of stuff do you think is going to be coming up for you while I'm gone?" Then, "And how will you be coping with that."

So a blurt, any error in judgement, probably shouldn't be ignored. The patient will be talking about it with everyone else anyway, so direct communication is more than called for. But did the patient contribute to the blurt? Only in having presented a certain amount of information that triggered something, some off observation or comment, and that needs to be discussed, too, the patient's input.

Which brings us to number (6), if we're counting Six ways therapists can recover from mistakes .

A little speech can go a long way toward rekindling the therapeutic alliance. Make it relevant to what was said, and be sure to assess what it is about the patient that contributed to your impulse to share:

(6) Last week, after you left, I thought I detected a little discomfort on your end.

I thought about what I said, that I'm going to climb Mount Kilimanjaro, thought about it a good deal. I tried to figure out why the impulsive share. So much information about my travel!. You might think it natural, after all, you travel a lot, and surely that contributed. But it didn't feel right to me, and I'm sorry. We should have just talked about how you'll be handling things while I'm gone.

Fact is, I hardly tell anyone about trips, certainly not patients. You share quite a bit about your travels, so maybe that had something to do with it, but I think there's more.

It is this wonderful quality you have that makes people want to share with you. It's true, you know, that a lot of people probably want to talk to you about all kinds of things.* So don't change.

But from here on in, I probably will.


Only say this if it is probably true. It does happen to be true about many, many people, and most of them don't even know it.


clairesmum said...

Worked a very long time with a therapist who taught me about boundaries, what they are, why they are necessary, how to have them, etc. Lots of hard work on both sides, as you can imagine. He did share briefly where he was going on vacation, or what he would be doing. (A hiking trip, presenting at a conference, etc.) Not a lot of detail, but enuf to reassure me that he would return safely. Over time, travel became a metaphor as well - going away and returning, moving into the world to explore and stay safe, traveling alone and trusting my own abilities, journey as a metaphor for life, etc. So, anything can be 'grist for the mill."
Your explanations of how therapy works from the therapist point of view are very helpful in understanding what to expect, how it works, etc. So are your descriptions of healthy and unhealthy relationships/families.

therapydoc said...

Thanks! When we get chummy it can work both ways, for or against the patient. That's why there are no hard and fast rule on this.

Anonymous said...

As you know, depends on the patient. Every therapist-patient relationship is a little different. My therapist of 5 years goes on vacation 2-3 times a year, totally reasonable. I usually go away also 2-3 times a year (different times, usually), also totally reasonable. We have fallen into a routine where she tells me, roughly, (Canada, Taiwan, France, California) where she goes, and that reassures me. I like being able to picture her face on a world map (I know, that' weird) and "know" where she is. If it's a place I've never been or thought much about, I'll google the country and I like feeling a bit connected to her. Beyond the location, we don't really talk about what she does or with whom and details like that. She once saw a new supervisor who suggested it was inappropriate and for a couple of trips said she didn't think she should say where she was going. It made me anxious and I was far more anxious while she was away. I felt awkward and strained; the change in "policy" led to so much anxiety about what else was going on. After a trip or two like that, she went back to her old way, and I relaxed and felt/feel sane while she was away. I realize it may not be for everyone, but it works for us and lets me keep feeling "connected" with her while she is away - something very essential for me. Interestingly, the therapist I saw for a couple of years before her, I didn't care where she went and was usually glad when she was away for it gave me a much needed break from a dysfunctional dynamic. Happily, realizing that was a factor in my breaking free from the damaging treatment.

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