Mind
Lives and emotions of any human: a psychotherapist

Lives and emotions of any human: a psychotherapist

Often the therapist is seen as controlled, resolute, imperturbable, should not be moved by patient stories, nor have insecurities, fears or phobias, should not feel anger, hatred or sadness, but always get away with it, in any situation. In light of the fact that every psychotherapist is first and foremost a human being, how would all this be possible? 

Listening to the song “Closer to the heart” (Rush, 1977) during reading is suggested.

 

Advertising message Here is another aspect of our work that perhaps is not talked about enough: the therapist can be a human being, with a normal, boring and sometimes even problematic life. A not perfect life. With normal gray areas or unresolved personal aspects. Like anyone, basically. Usually, by lying and deluding us, they tell us and sometimes teach us that we should be controlled, resolute, imperturbable. Of the “mini Buddhas”. Nobody says that, in reality, not only is this not possible but for therapies it is not even necessary. We cannot be robots because we are actually made of bone flesh, with a heart that beats and a mind that thinks, even with eyes that cry. Would you ever have said that? If we think about it, in the common representation, for example if the patient speaks of hard or raw things, the therapist should never be moved, let alone cry while watching the finale of “Gran Torino” or the training montage of “Rocky II” (When Adriana says: “Win, win”). Cabbage, so how do we deal with all those times when we are moved by hearing the patient’s poignant stories? Virginia Failoni talks about it in this article When the therapist is crying.

Or it is commonly believed that the therapist should not have insecurities, fears or phobias, that he cannot feel anger, hate or sadness and that he must always get by in any situation. How is this possible? Come on, we are therapists and we know that emotions exist! What is sometimes missing is the tool to read them: self-reflection. But if instead we circumvent alexithymia we understand well that it is precisely the authenticity of a therapist sufficiently “human” and physiologically in contact with his own areas of vulnerability, which favors a greater proximity and a good result of the therapy, especially with the so-called patients “Difficult” (for example with borderline nucleus or psychotic area). In fact, the painful emotions not recognized and possibly not clearly expressed by the therapist, if active in the session, however, they are perceived thanks to the natural emotional and somatic transmission conveyed by mirror neurons, and through a series of non-verbal signals. This may, in some cases, favor the activation of subtle maladaptive interpersonal cycles, impairing therapeutic success (Liotti & Farina, 2011; Dimaggio, Popolo, Ottavi, Salvatore, 2019). Furthermore, as human beings, we therapists also have our internal mental states and coping strategies to deal with them. Who swings in rumination, who in perfectionism, who in retreat. If on the one hand we know (or at least we should know) that coping makes us stay at work until 10.00 in the evening, risking burnout or badly managing a therapeutic relationship, we do not always manage to regulate them. Some coping strategies, by their nature, they strengthen the nuclear ideas connected to the maladaptive dysfunctional pattern (Dimaggio, Popolo, Ottavi, Salvatore, 2019), but in other ways they help us achieve great results, for example in terms of performance. In fact, starting from a wish of appreciation we could have a representation of ourselves of little value compared to another humiliating / critical. In an attempt to manage the emotions that would ensue, such as shame, just to name one, coping strategies are activated automatically. Among them perfectionism, the achievement of high standards, relational control, can be of help, deluding us that in this way the other will have no way of being critical. But is it really a functional way to manage self-representation related schema? (Dimaggio, Montano, Popolo, Salvatore, 2013). The important aspect remains connected to awareness and regulation of them. As we have mentioned, it is not always simple because by their nature schemes and coping are activated automatically and procedurally (Dimaggio, Popolo, Ottavi, Salvatore, 2019). Yet reflection on these aspects of ours allows us to understand how difficult it is to circumvent avoidance for an avoidant patient or to manage suspicious thoughts for a paranoid. On the other hand, if it is true that each of us has its own personality organization, traits that fall into the diagnostic categories of DSM-5 personality disorders, then why should we therapists be superhuman? Why repress or inhibit them? We would struggle and it would be more pathological to try to hide them than to recognize them, integrate them and regulate them.

Finally, another critical aspect: in the social age, patients know who we are even before they come to the office. They know our face, our age and our training. Access to phone numbers is so simple that you just have to save it in the address book to be able to peek at the WhatsApp image. So shouldn’t I feel free to use the funny photo with my granddaughter and her headband with the unicorn? Or the one with my partner? Or even less the one where I unleash myself at the disco? Or in front of a multitude of bottles of wine for dinner with friends? Share my political, religious or musical ideas on Facebook? And maybe I also struggled a lot to shake off that perfectionism and work workholism to enjoy my free time, having fun. And also sport, if I like doing Caribbean dances rather than fighting should I worry about it? According to the common imagination, yoga or pilates would be better for a psychologist. Zumba, we are already at the limit, but only for female therapists. For males the chess club is allowed and without exaggeration, that of swimming.

Advertising message If we feel free to be who we are, we no longer tremble when a patient asks us: “Have you ever smoked a joint?” Or: “Dott. but you did the therapy? “. Right now I don’t have any more problems if I go dancing and find the patient on Wednesday at 11.00 am and I don’t get any more worries if I let myself go to a karaoke and coincidentally the owner of the bar is a client of mine. How much effort did it cost me to go shopping in the patient’s atelier on Thursday at 20.00? Or if I have fun and mess at a rock concert, of course, without going beyond Articles 28 and 38 of the code of ethics! If there is one thing we have learned, though, it is that allowing others to get a glimpse of the more human aspects of ourselves can sometimes even be a turning point in therapy. Eg, recently, a patient said to me: “Doctor, does he look tired all right?”. Years ago I would have stiffened and replied hastily that it was all right by changing the subject immediately. This time, however, I almost relaxed, I replied that it was true, that I was tired because of a move that seemed to never end and that it was stressing me a lot. The patient listened to me with interest saying that he understood me very well since he had already made 4-5 moves in his life. We then discussed for a few minutes on this topic by sharing anecdotes and impressions. There was intimacy, empathy we were no longer doctor and patient, but two people in mutual mirroring of internal states and mutual weaknesses in which the patient can venture into an unexplored but relational world in a safe context (Hill, 2017). a patient said to me: “Doctor, does he look tired all right?”. Years ago I would have stiffened and replied hastily that it was all right by changing the subject immediately. This time, however, I almost relaxed, I replied that it was true, that I was tired because of a move that seemed to never end and that it was stressing me a lot. The patient listened to me with interest saying that he understood me very well since he had already made 4-5 moves in his life. We then discussed for a few minutes on this topic by sharing anecdotes and impressions. There was intimacy, empathy we were no longer doctor and patient, but two people in mutual mirroring of internal states and mutual weaknesses in which the patient can venture into an unexplored but relational world in a safe context (Hill, 2017). a patient said to me: “Doctor, does he look tired all right?”. Years ago I would have stiffened and replied hastily that it was all right by changing the subject immediately. This time, however, I almost relaxed, I replied that it was true, that I was tired from a move that seemed to never end and that it was stressing me a lot. The patient listened to me with interest saying that he understood me very well since he had already made 4-5 moves in his life. We then discussed for a few minutes on this topic by sharing anecdotes and impressions. There was intimacy, empathy we were no longer doctor and patient, but two people in mutual mirroring of internal states and mutual weaknesses in which the patient can venture into an unexplored but relational world in a safe context (Hill, 2017). “Doctor looks tired all right?”. Years ago I would have stiffened and replied hastily that it was all right by changing the subject immediately. This time, however, I almost relaxed, I replied that it was true, that I was tired because of a move that seemed to never end and that it was stressing me a lot. The patient listened to me with interest saying that he understood me very well since he had already made 4-5 moves in his life. We then discussed for a few minutes on this topic by sharing anecdotes and impressions. There was intimacy, empathy we were no longer doctor and patient, but two people in mutual mirroring of internal states and mutual weaknesses in which the patient can venture into an unexplored but relational world in a safe context (Hill, 2017). “Doctor looks tired all right?”. Years ago I would have stiffened and replied hastily that it was all right by changing the subject immediately. This time, however, I almost relaxed, I replied that it was true, that I was tired because of a move that seemed to never end and that it was stressing me a lot. The patient listened to me with interest saying that he understood me very well since he had already made 4-5 moves in his life. We then discussed for a few minutes on this topic by sharing anecdotes and impressions. There was intimacy, empathy we were no longer doctor and patient, but two people in mutual mirroring of internal states and mutual weaknesses in which the patient can venture into an unexplored but relational world in a safe context (Hill, 2017). Years ago I would have stiffened and replied hastily that it was all right by changing the subject immediately. This time, however, I almost relaxed, I replied that it was true, that I was tired because of a move that seemed to never end and that it was stressing me a lot. The patient listened to me with interest saying that he understood me very well since he had already made 4-5 moves in his life. We then discussed for a few minutes on this topic by sharing anecdotes and impressions. There was intimacy, empathy we were no longer doctor and patient, but two people in mutual mirroring of internal states and mutual weaknesses in which the patient can venture into an unexplored but relational world in a safe context (Hill, 2017). Years ago I would have stiffened and replied hastily that it was all right by changing the subject immediately. This time, however, I almost relaxed, I replied that it was true, that I was tired because of a move that seemed to never end and that it was stressing me a lot. The patient listened to me with interest saying that he understood me very well since he had already made 4-5 moves in his life. We then discussed for a few minutes on this topic by sharing anecdotes and impressions. There was intimacy, empathy we were no longer doctor and patient, but two people in mutual mirroring of internal states and mutual weaknesses in which the patient can venture into an unexplored but relational world in a safe context (Hill, 2017).

If, in some ways, we are lucky because we are able to understand the human mind a minimum and we know some psychological mechanisms, despite this we remain human beings. And, as such, we have our critical points. But if thanks to our personal work (we talked about it in the article The plot between supervision and personal psychotherapy), we have laboriously abandoned coping, we have overcome fear of judgment or criticism, and we have also seen how hard it was, then we know what we are asking of our patients. We may even become modeling encouraging enough for each other. We know that it is possible to work on the pattern, on emotions, manage normal relapses, explore healthy parts of oneself or create new ones if necessary. Without knowing our way of thinking, to be in relationship, to work with internal structures is implicitly learned by patients and this is often useful in emotional regulation. For example, a frightened or dysregulated patient can be helped by our internal regulated state, but not only by it. When patients observe our funny behaviors, our mistakes live and “learn” how they can be like this, work well even if not perfect, for example. This process promotes integration: parts of self and of the other, which may seem dissonant, are actually part of the individual as a whole. In the eyes of the patients we remain therapists present, welcoming and validating even if we turn a cup of tea upside down while filling out the invoice, or we give two appointments at the same time. Aren’t we always us? Or whenever a patient of mine mentions places, famous shops of my city that I don’t know and makes fun of me for this, or when chronic rhinitis is in the acute phase and during the session I consume 3 packs of tissues looking for them around like a zombie addict, aren’t we always that therapist there? In short, the paradox is that a healthily “decompensated” therapist appears intact in the patient’s eyes. The therapist is a human being with his healthy parts and his frailties, but still remains stable in the patient’s mind, a person who responds adequately to his needs (Meares, 2014). We remain intact even if sometimes we happen to …….? And here each of us can think of his own apparently “decompensated” behavior. Sincerely!