One Among Many
Veryhopeful posted a question on the Psych Cafe forums and the more I thought about answering her, the more I realized it was an excellent topic for a post. So with her kind permission, I am repeating the question here, then attempting to answer it.
Does anyone find it strange that the T is so important to us but yet he has so many clients. How is it possible for them to really care or separate each persons “stuff”. I’ve asked him this because it really bothers me that I have one of “him” in my life and he has dozens of “me” in his life. We all want to feel important to them but are we really? It’s so personal for us but not for them; like they are just an illusion or some emotionless guide…But what bothers me about him is that he takes no break in between clients and I find that really odd.
I think it is important to say up front that I have also struggled with these questions and feelings – still do from time to time – so what I am saying here is born out of a long struggle to understand. And even with this knowledge, the feelings can still be very strong at times. The truth is that the boundaries in therapy add an ambiguity to the relationship that makes it easy to question the authenticity because we often do not get the kind of feedback about our therapist’s feelings that we can get from a friend or other loved one. Not sure how true this is for everyone else, but I get NOWHERE trying to discuss BN’s feelings about me, or about anything else, for that matter. 🙂
The first mistake I think we make is to see love and caring as a zero sum game. As if each person has only a limited amount of love and when the quota is filled up, they will feel nothing for anyone else. This is often based on the fact that when we were children, parental resources of time, attention, affection and compassion were in short supply. This was even more exacerbated if we needed to compete with our siblings for what little there was. I strongly suspect that I have had life long problems with my next older sister because my father stopped abusing her when he started abusing me and she was angry and jealous over the loss of his “attention.” Warped yes, but I know from my memories that any gentleness or care I received from my father was usually the prelude to abuse. So I treasured those memories and dissociated the abuse so I could hang onto the crumbs of care provided. I think my sister resented it when she saw that transferred to me. So knowing BN has other clients can sometimes lead to my feeling like I need to compete for his attention.
But the truth is that God (substitute your conception of a higher power here if it works better for you 🙂 ) is an inexhaustible supply of love and in His economy we always have enough to meet our needs. So I am never limited in the number of people I can love or care for. Nor are our therapists. Each person who walks through their door is a unique human being with their own stories and struggles and I think it really is possible to care for each of them. I volunteer on a Crisis Line and can truly say that I really do care for each person I talk to even if it’s for a short time. There are some people you experience a better chemistry with and a stronger sense of connection, but the care is the same for each person.
Now, while we are not limited in the amount of love we have to give, we are limited by our time and energy. We have only so much time and so much energy to devote to our relationships. General rule of thumb, the more important the relationship, the more time and energy we spend on it. Our spouses and children probably get more of our time and energy than our friends, and our friends more than our acquaintances. The therapeutic relationship is unique, and a bit of an odd duck, in that the therapist is lending the kind of energy, depth and focus that we reserve for our deepest relationships, but is doing so for many people. Think about the level of engagement and focus your therapist brings into your session, and his own needs being excluded. Doing that for 6-8 hours day sounds pretty exhausting doesn’t it? No one would be capable of keeping up that level of attention and focus all the time. They would need rest, and time to attend to their own needs. So part of the reason for the boundaries in therapy is to protect the therapist’s resources so that they can bring that focus and engagement to bear for the hour or two a week they do spend with you. I think a lot of our frustration with the boundaries is that we long for 24/7 access to that person we have for one hour. That person doesn’t exist. I do not mean that you are not seeing the real person; I deeply believe that therapy is most effective when both people are authentic. But no one could keep that level of focus and attention of all the time, around the clock. They would become so drained that eventually their survival instincts would kick in, at which point they become completely self-focused. This is exactly what you see happen when a therapist does not hold clear boundaries and gives more than they are really comfortable giving. Eventually they abandon their patients to save themselves. Everyone gets hurt.*
On the other hand, while our contact is limited, I think while we are with them, we get the best of them. We do not see the grumpiness, or irritation or moments of selfishness or fear or judgment, and don’t get me going about dirty socks or who has control of the TV remote. 🙂
So now we understand why a client has to be a client to protect the work, but why can’t we be “special” and as important to our therapist as they are to us? One of the truly difficult truths about therapy is that while it is a deep, genuine relationship, there is an asymmetry to it. Except for payment, it all flows in the direction of the client and is focused on their needs and feelings. Providing care and encouragement and acceptance, while important functions of a therapist, are not their only responsibilities. They are to observe us and collate data and attend to our behavior in order to reflect to us the patterns of our behaviors, and help us bring into consciousness our unconscious beliefs and behaviors. They use their insight, experience and education to make sense of our behavior and place it in the proper context. This requires a certain detachment that will allow them to see us clearly. Nothing is at stake for them in the relationship with us, so they are not risking anything to help us see the truth. They do not need us to like them (I am sure its much more pleasant when we do, it’s just that they won’t make it a goal of our therapy for us to like them) so they are willing to reflect the truth, some of which can be difficult to hear. BN has said some of the most beautiful things I have ever had said to me. He has also said some of the hardest, knowing how they would hurt me to hear, but knowing I needed to hear them. If a therapist allowed themselves to need us, if we became as important to them as they are to us, how would they manage to be objective enough to understand our behaviors? Or take the risk of telling us hard truths with so much at stake for them? Therapy also means that sometimes our therapists have to let us sit with our pain (Why your therapist seems cruel, but really isn’t); again, it is more possible to do that if you keep a certain distance.
I do not believe this distance comes naturally. I think that therapists have to work to stay in the right place in relationship to us. Too far out and the vital emotional connection cannot take place. Too close in and they lose their effectiveness. My guess is that as a therapist matures, this part of the job gets easier to maintain, more than likely because they have learned the hard way the cost to the client if it is not. But it’s also my guess that this takes a lot of effort and self-awareness in the beginning. I know on the crisis line, that people who touch me really deeply can sometimes be the hardest calls, because my reactions are more intense, I lose some of my objectivity and start making assumptions based on my own feelings instead of continuing to listen to what the person is actually saying. As lovely as it would be to just relax and be a friend, and there a number of callers I’d love to get to know better, that is not what I am there for nor is it my role in their life. My role is to provide them a safe place to talk and a clear reflection of what they are saying.
And now we come to how can they move on so quickly to the next client? If I were important to them, if the relationship was real, shouldn’t it be harder to move on to the next person? An important part of good boundaries is knowing what is your responsibility and what lies in your control and what is the other person’s. Ultimately, we are each responsible for our own needs and our healing. No one can do it for us because that is impossible. They can come alongside us and provide for our needs and aid us in our healing. We can only know ourselves in relationship and we need other people. But we can only ask for what we need from another person, not demand it. And we are the ones that use what is given. So, a good therapist, no matter how much they care about us, trusts us to take care of ourselves. So when we leave their office, they do not turn us “off.” They trust that they have given their best to us in the session, and that we will take it from there until we see them again. Part of knowing you are a separate person is to be able to understand that your feelings are separate from another person. You cannot carry another person’s feelings (you can try, its called enmeshment and please trust me, it does NOT work well). So therapist’s do not carry ours. If we are in pain or anxious or grieving, or joyous, they attend to that in session, but trust us to attend to it when we leave, seeking out help from any and all of our resources as needed. And then they turn their attention and focus to the next person. Not because they don’t care about us, but because they trust us.
I think that stance communicates something very important to us. I know I have mentioned that BN has a very generous contact policy outside of session, but he NEVER initiates contact unless he is calling about a schedule change. On the other hand, if I reach out, he is very responsive. And that tells me on a very deep level, much more effectively than words could communicate that BN knows and respects that I am a separate person with my own feelings and am capable enough to manage myself. He trusts me, which at times has meant the world, since I can struggle to trust myself.
So we bring our needs and vulnerabilities into the room and trust them both to the person across from us. For deeply wounded people, this can be the first time we have risked that. And the first time we have consistently received the loving response we have needed and longed for. This attention teaches us our worth and heals us and can fundamentally change how we see ourselves and the person we understand ourselves to be. How could they not be vitally important to us? BN is the source of my earned secure attachment, the steady base I return to in times of need. He is vitally important to me and so woven into who I am at this point that I could not extricate him if I wished to. He stands very close to the center of who I am. The same thing is not true for him. While I know that I have affected him in turn – he has told me so – I am not someone he needed, so I have not affected him as deeply and am not as important to him. But it is crucial not to confuse importance with worth. The importance of another person to us is based on our need and is in some ways about who we are, not about who they are. Worth is a quality intrinsic to a person and about them. So a therapist can see their client and know that the person is worthwhile and capable of being vitally important to another person, but cannot let themselves be that person.
Recently, BN was away on a long weekend and I wasn’t aware he was out of the office. I had sent an email and not gotten a response and ended up calling. In discussing what happened, I said that it had stirred my feelings of not mattering and being forgotten. BN said something very important to me. He told me that not being in the forefront of someone’s mind is not the same as being forgotten. It made me realize that I focus on all kinds of things in the course of a day, and thoughts of my loved ones come and go. I do not love them any less when I am not consciously thinking of them. I believe the same is true of our therapists. But I will also freely admit that it would be nice to not feel like we think about them orders of magnitude more than they think of us. But I try to remember, it’s not a bug, it’s a feature. 🙂
*Note: I want to make it clear that this is not the client’s responsibility. You are free to ask for whatever you want, it is the therapist’s responsibility to model good boundaries and set their limits in a sustainable place. When this scenario occurs, it is the therapist who is at fault. Well-intentioned, but at fault. There is good reason that boundaries are so strongly stressed.
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