About the author: Richard Alexander, M.A., is a retired psychotherapist who specialized in addiction treatment and couples therapy. In 2004, after many years of adjunct teaching, he left clinical practice and became a full-time faculty member at Muskegon Community College. During his nine-year tenure at MCC he won several Teaching Resources Awards from the American Psychological Association.
Richard lives in the Grand Rapids area. For the low, low price of a decaf latte and gluten-free pastry he’d be glad to sit down with you and converse about psychotherapy, teaching, cooking, pickleball, retirement, or whatever else you’d like. His gmail address is alexander49546.
My first run-in with the therapeutic process was in tenth grade: a parent-initiated two-hour meeting with the school psychologist, triggered by a looming “F” in Social Studies and a “D” in English. He threw a few brief intellectual and personality assessments my way, then we talked for a while.
In addition to addressing the problem at hand, he noted my tendency toward smart-assedness, which to my finely tuned adolescent mind was the height of cleverness. He contended that adults were highly unlikely to see it my way, and that I should modify my behavior in order to avoid certain unspecified but unpleasant consequences. Perception, he told me, is everything.
I blithely proceeded to ignore his advice. Nevertheless, life continued relatively calamity-free until the middle of my third year of graduate school in clinical psychology, when I unintentionally but brilliantly managed to both disappoint and antagonize my program director. He interpreted my (mis)behavior as an attempt to sabotage my career in utero, so he ruled that if I wanted to remain in the program I had to get my sorry self into psychotherapy and figure out what the hell was going on.
The department maintained a list of psychologists who were willing to work with us financially squeezed grad students for a fraction of the going rate. I made an appointment with someone I thought I’d like and who might not make me sweat too much: age late 40s, very smart, ethnic background similar to mine, and by all reports a nice guy.
Dr. H and I eventually met for about twelve fifty-minute sessions; nowadays it would be considered brief psychodynamic therapy. Time has blurred most of the details of the process, but I still can vividly recall two brief scenes from our first session.
Scene One: Dr. H escorted me into his office, gestured toward a traditional wingback chair with blue and white floral upholstery, then settled into his iconic rosewood and black leather Eames lounge chair. I thought, “What? You have that immensely cool status symbol and I get my grandma’s furniture? That’s not right.” Opting for caution, I said nothing.
Sometimes a chair is more than just a place to sit. I wonder now: Did Dr. H believe that his patients would perceive a homey wingback as welcoming or comforting? Did he intend for the pricy, contemporary Eames to convey a sense of prestige or “one of us” to his primarily suburban, upper-middle-class clientele? Did I react to the disparity because it underscored the power imbalance inherent in our relationship?
Perception is everything.
Scene Two: Dr. H indeed proved congenial, although at first he preferred to sit back impassively (in his Eames chair) and ask only the occasional question, allowing me to do most of the talking. About a half-hour in, I mentioned how two of my father’s closest family members — his only brother and his youngest son from his first marriage — died young, under tragic circumstances. Dr. H leaned forward intently. I thought, “Aha, a response! He felt that was important.” I mentally filed this away for later use.
Sometimes a seemingly innocuous behavior can have unanticipated consequences. For all I knew, Dr. H could have been stretching out a stiff lower back. But at that moment I was certain he thought my anecdote was interesting, which therefore deemed me a patient worthy of his close attention, which made me feel good, which then made it more likely I’d revisit that topic regardless of its actual importance.
Perception is everything.
But I come to praise Dr. H, not bury him.
His strength lay in his ability to forge a therapeutic alliance: a collaborative relationship based on understanding, acceptance, and trust. This enabled Dr. H to nudge me away from blaming my program director for the mess I was in (not that he didn’t play a part; he had his own issues with self-perception and an inflated ego) and toward focusing on how he might have interpreted my behavior.
Let’s say you’re a full-time psychotherapist. For at least 25 sessions every week, you’re continuously paying attention to: 1) what your clients are saying and doing; 2) what might underlie those words and behaviors; 3) what you should (and shouldn’t) say or do next, and; 4) which intrusive, distracting thoughts need to be ignored (hint: all of them). And when not in session, you’re composing progress notes and reports, staying current with professional development, and communicating with referral sources and other contacts.
You’re also faced with maintaining self-awareness. While in session, or even when thinking about work, you have to keep up with the do-si-do of how you’re perceiving your clients, how those perceptions might influence your behavior, and how your behaviors can in turn influence how your clients perceive and act toward you.
Whew. Perception is indeed pretty much everything. That’s one reason why psychotherapy is such challenging work, why it’s a craft that calls for ongoing training, supervision, and self-examination — including some sort of mindfulness training and development.
I’ve certainly committed my share of self-unawareness mistakes. For example, more than once I walked right into the YAVIS trap: responding to a client in a counter-therapeutic way because the person was (at least four of) Young, Attractive, Verbal, Intelligent, and Successful. Or when doing family therapy, I failed to recognize that I was allying with the child against the parents, not as a therapeutic technique, but because the child’s situation resonated with mine at that age.
I should’ve taken a poetry class in college. As Robert Burns knew, more than two centuries ago:
O wad some Pow’r the giftie gie us
To see oursels as others see us!
It wad frae monie a blunder free us,
An’ foolish notion…
I suspect that for most of us in the business, our “power” relies on clinical and life experience, leavened by blunder-engendered humility, ongoing training, and the ministrations of an astute supervisor or two. And, for some, a good therapist. For me even now, five decades and two retirements post-Dr. H, self-awareness remains a work-in-progress: difficult, glacial, exasperating, necessary.
(Cartoon panels courtesy of Nina Paley, Mimi and Eunice, 12 October 2010)
