After writing about why therapy is so important to me, I wanted to focus on my therapist as a person today, because at the time I was trying to figure out treatment options, I wondered a lot about what a relationship with a therapist actually is like. There’s plenty of information online and in print which explains the characteristics of different schools of thought or styles, but very little that gives insight in what it is like to attend sessions. As a result, I decided to write about a person who appears in the background of most of my posts, but has never been the subject of much discussion.
The role of the therapist in CBASP is different from other approaches in so far as you get to know the therapist as a person. This doesn’t mean that we chat away for an hour during our sessions, but he offers me insight into his personal experiences when we are discussing my problems, for example.
The key word is “controlled personal involvement”, because obviously the therapist needs to take care that everything remains professional, but building the relationship is actually part of the therapeutic process. It’s based on the assumption that chronic depression is the result of an “absence of felt interpersonal safety” – in simpler words, one is afraid of getting hurt, shamed, punished or abandoned by other people. Through the relationship with your therapist, you interact with another person without falling into old patterns of fear or avoidance, and eventually start to transfer this into everyday life and other relationships.
I know where the taboo of the personal involvement stems from historically, and also understand why it is so important for psychoanalysis. However, I am very glad and relieved that in CBASP, the therapist does not remain such a stranger as this would only reinforce the pathological thought patterns. When trapped in a cycle of negative self-beliefs, for example, the patient/client would only create more negative thoughts about him- or herself because there is nothing to interfere with them. In contrast, during a CBASP session you receive a lot of feedback about yourself and how you behave, and the therapist will repeatedly ask if you noticed his/her own behaviour when you interact. Through this, you are forced to acknowledge the reaction you actually evoke in the therapist, as opposed to the negative expectations you usually might have harboured. And it also works the other way around, when you are asked how certain behaviours by the therapist made you feel.
Additionally, the disclosure of personal information and experiences “balances out the scale” a little more: I experience my therapist as human and fallible – a person who faces challenges and problems as well, but manages to overcome them. If he was this “black box” where you only see what goes in and comes out, but not what goes on inside, I would have cast myself in the role of the “flawed one” while attributing to him the role of a superior being, thus putting myself down. Since I do hear about his struggles too, though, there’s no chance of this happening and ultimately, it allows me to be more open about my perceived shortcomings as I know he is not perfect either.
The first time I met my therapist, he struck me as very cordial. More than just friendly; he radiated kindness. In fact, this caught me somewhat off guard… he was treating me like I was a special guest, but not over the top at all.
Much later, we had a discussion about mindfulness and he mentioned Thích Nhất Hạnh’s “The Miracle of Mindfulness”, citing a story by Tolstoy which is printed in the book. In this story, an emperor searches for the answers to three questions which, if he found them, would grant him the wisdom to never stray in any matter. The three questions were: “What is the best time to do each thing?” – “Who are the most important people to work with?” – “What is the most important thing to do at all times?”
In the end and after adventurous plot twists, the answers are revealed to the emperor by a hermit: the most important time is now, because the present is the only time over which we have control. The most important person always is the one you are with at the moment, because you never know if you’ll ever deal with any other person. The most important thing to do is making the person next to you happy, because “that alone is the pursuit of life.”
When I read this story, I suddenly could put my finger on what makes my therapist’s behaviour stand out: he treats me according to the principles from Tolstoy’s story. In our sessions, he’s always fully concentrated and there; I can’t remember a single moment when he wasn’t. And during the hour we have together, he makes me feel like I’m the most important project he has going on – by listening carefully, by taking what I have to say seriously and not dismissing anything casually, by not straying from the topic, by respecting my feelings. He gives me positive feedback and praise when I did something right; not inflationary, but always in relation to a result. He doesn’t create spaces where negative thoughts could creep in, and he appears genuinely happy for my successes. When we bide each other goodbye, he will often say sentences like, “I’m already looking forward to our next session / to your next situational analysis.” In short, he makes me feel appreciated and like he values our time and work together.
Therapy scenarios are designed to create intimacy: two people meet in a secluded room and talk about highly personal things, some of which could be considered secrets. You make yourself vulnerable, sometimes without having planned to. If you are sitting in this room with the wrong person, I don’t think much good can come out of it – trust is a fundamental requirement and if there is anything about your therapist which undermines its development, you will not work with, but against the therapist through avoiding or openly resisting him or her. Or stop seeing the therapist.
During the first sessions, I would discuss facts without holding back because I wanted to do whatever necessary for recovery. By that time, I thought I was already laying myself out in front of my therapist, but later I realized that disclosing facts is different from disclosing emotions, and the latter was something I had to learn first and still am learning. Head knowledge gets you only so far, but to let someone see and feel your emotions I only managed through experiencing my therapist session after session as a person who would not take this and use it against me.