Dear Psychiatrist/Psychotherapist: Admonitions and Suggestions from a Mental Health Consumer

 

Psychotherapy and dispensing psychiatric advice are easily as much arts as they are sciences, hard science or otherwise, as recently demonstrated by new books by leading psychiatric publisher Guilford Press, which lists three recent books on how to be a better psychotherapist—which basically come down to but one suggestion: listen, really listen, to your client.  That sums it up well, psychiatrist/psychotherapist:  you are, first and foremost, not there to dispense unsolicited advice, much less bark mandatory orders, but to listen, really listen, to that troubled human being sitting across from you; that troubled human being who’s most likely have gone through life’s wringer in ways, and to an extent, you can neither fathom from your own experience, or find automatic guidance for in any standard psychiatric textbook!

 

So, first of all, listen, really listen, to your client, and put this first.  Before dispensing advice or telling the patient who’s before you what to do.  Phrase things such as suggestions and admonitions in an interrogatory way; ask, not tell, your client directly, preface your remarks with, “Have you considered that…” or “Have you thought about…,” for example. And elicit honest feedback from your client!   If your client is unsure of what you are suggesting, if the client has doubts, or thinks what you offer won’t work, and above all, if what you suggest makes your client feel uneasy or uncomfortable, you not only want, but you need, to know about it!  Enforced pseudo-certainly through engineered silence only hurts both you and your client, and detracts from, undermines, the therapy relationship.

 

Second, ask questions of your client and his/her background.  You, therapist, can’t automatically know everything you need to know about your client, not even from the most extensive psychiatric interview, but you need to find out, because as you and the client go along, ofttimes the must unanticipated, the most unexpected, will make their way to the fore.  And remember always, therapist, there is no such thing as an obvious question, or an obvious answer, so don’t ever assume there are.  What you don’t know, what you are unaware of, you are just ignorant or unaware of, period.  Further, questions to the client also show you are directly concerned about him/her, and not just play the role of an authoritative “expert” who always knows everything.  Because such, even if inadvertent, can seriously not just undermine, but also directly jeopardize, the therapy relationship.

 

Remember always, psychiatrist/psychotherapist, your first duty in therapy or dispensing psychiatric advice is to help the client help him/herself, not transform the client into an obliging robot.  You are a guide, not an automatic “expert” who knows all the answers.  Realize also, psychiatry is forever evolving, new knowledge and techniques of practice are always coming along, so it is important to not only be abreast of these, but to communicate to your client that you, too, are a fellow human being also searching for answers, not some automatically infallible guru.  For even the best of us can make mistakes, mistakes that seriously rouse anger and doubt about efficacy in the minds of the clients.  Such as the psychiatrist who asked me in all sincere honesty, “What did you do to make your parents abuse you?”  (Emphases as they were originally in the psychiatrist’s phrasing.)  The “correct” answer is, of course, “Nothing.”  (I did not answer his question this way, though I felt it.)  I can no more cause someone, even a parent, to abuse me any more than, as a woman supposedly having too much to drink or wearing too short a skirt, cause a man to rape me!  Same way with my most recent therapist, who alleged I was not “subtle” enough in understanding my father who called me “sissy” and “n****r-lover” repeatedly at the top of his lungs when I was a child and adolescent!  These two examples show conclusively that, even if inadvertently, the failure to make good word choices can unravel therapy relations!  For, in both these cases, things were never, ever, the same between me and the therapist.

 

That all sums it up.  These are things I’ve wanted to convey for a long time as a mental health consumer to my “professional healers,” and these are things I think are absolutely vital to a good, constructive therapy relationship.  Summarizing, they are three in number, and are an absolutely needed and vital three:  Listen, Ask Questions, Elicit Feedback.  Remember, your client is an autonomous human being, not just an empty vessel for you to pour into whatever you wish.  For therapy to work, it must be an exchange between two people.  Yes, psychiatrist/psychotherapist, you are “first among the two equals here;” but you are neither a god nor and infallible guru, and your expertise needs always to be tempered with a sense of humility, and awareness of just how fallible you really are. Remember, psychiatrist/psychotherapist, you also make mistakes.