What Does the Therapist Know? And Why Does It Matter?

Ann Green, PMHNPHugh Polk, MD
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Welcome to a conversation between two social therapists who meet regularly to share and advance our therapeutic work. We hope these dialogues can support and stimulate others who are integrating developmental conversations into their therapeutic practices and personal growth. See the first post in the series for a brief explanation of what social therapy is and the perspectives we’re coming from in our dialogues.

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Ann: One of the things that’s still most challenging for me in doing therapy is resisting the impulse to come up with solutions to my clients’ problems. I find the role of “answer woman” very seductive. It’s not only because the people who come to me for help usually assume, at least at first, that help means solutions. Maybe they’d even say that’s what they’re paying me for, and I want them to feel they’re getting their money’s worth. I get that my trying to seem smart is about me, not the client. But I don’t always win the battle. What about you, Hugh? In doing therapy, do you experience the temptation to be a know-it-all?

Hugh: Oh, I outgrew that years ago. Just kidding! That temptation is always lurking, inside and outside the therapy office. But it’s not just about us wanting to be a smarty-pants. I think all of us—we, the therapists, and our clients—experience a kind of craving for a moral of the story, a solution, a product, that everyone can take home with them. As I understand it, social therapy, as a practice of not knowing, is a form of resistance to that fatal attraction we all share. It can empower the members of the group, including the therapist, to go beyond giving and getting answers to doing something more creative and developmental together.

Ann: What does that look like in your practice these days?

Hugh: Here’s one example. Last week a young woman in one of my groups, who’s just recently started college, asked for help because she was having trouble relating to the other students. In conversations with them, she said, she felt intensely self-conscious, imagining that they were making judgments about her appearance and thinking that she was “just a small-town girl with nothing interesting to say.”

A couple of people began by saying what they thought was “really” going on, having to do with race, class, or gender. Others offered advice, and some tried to comfort Melanie with stories of how they too had had a hard time fitting in when they first went to college or got a job or moved into a new neighborhood. I also felt an urge to say something insightful that would help the group to help Melanie see things in a new way. But one person, Derek, took us in a different and more interesting direction. He had a question for her. “How do you know what these other students are thinking, Melanie?”

Ann: So he wasn’t telling her what he knew. He wasn’t saying she was right or wrong in assuming what she thought or that it was “all in her head.” He was asking her how she knew what she knew. I like that! It’s the kind of philosophical question that can open a gate in a conversation and take everyone down some new roads.

Hugh: That’s a good way to describe it, I think. Therapy, as it’s usually practiced, is often about saying “knowing” things such as analyzing or explaining people’s behavior. I’m coming more and more to see that it’s one of those activities that seem important in theory but don’t have much of an impact in real life.

After Derek said what he said the conversation changed—it slowed down, became more intimate and open. Talking about their responses to Melanie, one person said he “related to” her pain and wanted to make her feel better. Another said she had been quiet because she didn’t have something smart to say. A new-ish member of the group said she wanted to solve this problem for Melanie—she thought that’s what we were supposed to do here. In this part of the conversation, they seemed less invested in knowing what to say, and more open to exploring what it means to do not knowing. Including me. I didn’t feel the pressure to know what Melanie’s problem was or how to solve it, and the group wasn’t expecting that of me. I was free to go exploring with them. We were building something—without knowing what—with what Derek had offered. Gradually the group was coming to see that the need to say knowing things had kept us distant from one another earlier, and constrained us from exploring together some new emotional experiences.

Ann: In my experience, that way of talking is hard to do—but it can also be fun, even when what you’re talking about is painful.

Hugh: If by hard, you mean awkward and uncomfortable… definitely. And it’s usually not as simple as going from Point A to Point B. But it’s often more intimate, absorbing and interesting. And it was fun, with Derek’s question leading to others. Eventually, I asked the group “What if we don’t know how to have this conversation?” I was a little hesitant about that one, because I didn’t want to sound like I was criticizing them—I didn’t feel critical, but I thought it might seem as if I were. Then I reminded myself that improvising with the group means taking the chance that I might say the wrong thing. But it turned out to be useful in opening up the question of what to do when you don’t know what to do.

Ann: As therapists we’re trained to analyze, explain, interpret… The idea is to get to the “bottom” of what’s going on, to discover its “root cause,” in order to help people out of their emotional difficulties. But it turns out that, ironically, the language of knowing closes down emotional conversation. It defines what things are rather than allowing us to explore how they might become otherwise. We want to help our clients to create new ways of talking, and living their lives, right there in the group.

Hugh: We have to be willing to work—and support our clients to work—without needing to come up with a finished product. Come to think of it, it’s no different in the conversations that you and I are having here, where we’re also trying to be mindful of not coming to conclusions.

Ann: Is that a wrap?

Hugh: Let’s hope not.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

14 COMMENTS

  1. Thank you for sharing your thoughts about how therapists can best be with the people that they support. Your description of being a humble presence reminds me of the practice of Peer Supported Open Dialogue, POD, or Open Dialogue, both ways of being with others in dialogue rather than offering goal directed, advice giving interventions. I also remember an article about avoiding becoming a colonizer when offering any type of counseling or support for individuals or families in which we assume that we know best or better than the individuals we work with. Thank you for the “dialogue,”

    • Thanks for your thoughtful comment. I’m also a fan of POD and Open Dialogue. I think it’s important for therapists to not assume that we know best or better than our clients. However, I think we have an obligation to offer our opinions, responses and thoughts to them, not as “right answers” or explanations of what’s wrong with them, but as starting points for joint exploration of what might be holding them back from becoming all that they might want to become. I appreciate your highlighting the danger of becoming a “colonizer” with our clients.

    • I agree, Sam. I think conversation should be performed as a creative, improvisational activity that people make together where we don’t consider our opinions to be right but rather, simply, our opinions which could be considered as part of what we’re creating together in speaking. What you’re saying is so important. Thanks for the comment.

  2. “As therapists we’re trained to analyze, explain, interpret… The idea is to get to the ‘bottom’ of what’s going on, to discover its ‘root cause,’ in order to help people out of their emotional difficulties. But it turns out that, ironically, the language of knowing closes down emotional conversation.”

    My experience, and research into what’s going on, with “therapists” is that you’re trained to label people with one, or many, of the DSM disorders. You need to do this, first and foremost, in order to get paid, which is your primary goal. Then you need to psychiatrically educate people about your DSM labels, instead of making the discussion of people’s real problems your first priority. Thus, you distract, and literally prevent or delay, the people you claim to be helping, from getting “to the ‘bottom’ of what’s going on, to discover” the ‘root cause,’ of their concerns. Instead it all becomes a discussion about your DSM labels, instead of a discussion of the clients’ concerns. And this has resulted in your industry’s systemic failure “to help people out of their emotional difficulties.”

    But I do agree, “it turns out that, ironically, the language of knowing [all about your ‘invalid’ DSM disorders] closes down emotional conversation,” or any conversation, about the real concerns of those you claim to want to help.

    A quick example, how do you help a mother who has concerns her child was abused? You can’t, because according to your DSM, you can’t EVER bill to help ANY child abuse survivor, nor any child abuse survivor’s concerned parent, EVER. Unless you first misdiagnose that person with one of your billable DSM disorders.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    The same DSM flaw exists in regards to DSM “bible” believers’ inability to EVER help ANY rape survivor EVER, as well.

    https://www.theguardian.com/lifeandstyle/2019/mar/27/are-sexual-abuse-victims-being-diagnosed-with-a-mental-disorder-they-dont-have

    And this inability for ALL therapists/psychologists/psychiatrists, to EVER bill to help ANY child abuse or rape survivor EVER. Has resulted in the vast majority of those labeled/mislabeled with the DSM disorders today, being child abuse and/or rape survivors.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    Meaning today’s so called “mental health” industries, are in reality, systemic child abuse and rape covering up industries. But they are NOT scientifically valid “mental health” industries.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    I do believe that given the DSM’s intentional, prevention of its “mental health” workers to actually bill to help child abuse and rape survivors, which has resulted in massive misdiagnoses of millions of child abuse and rape survivors. That our society needs some entity – other than the systemic child abuse and rape covering up “mental health” industries – who’ve already massively betrayed child abuse and rape survivors for over a century. We need some group that actually wants to help survivors of trauma, instead of the DSM believers, who just want to distract people with DSM labels, then neurotoxic poisoning survivors of trauma.

    “All distress is” NOT “caused by chemical imbalances in people’s brains.” And all this systemic, child abuse and rape denying and covering up by our “mental health” workers, has also functioned to aid, abet, and empower the pedophiles and child sex traffickers, which is destroying our country. These systemic crimes need to end.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
    https://community.healthimpactnews.com/topic/4576/america-1-in-child-sex-trafficking-and-pedophilia-cps-and-foster-care-are-the-pipelines

  3. “I think all of us—we, the therapists, and our clients—experience a kind of craving for a moral of the story, a solution, a product, that everyone can take home with them.”

    Can’t say I thought much of the ‘product’ my wife returned home from a psychologist with (He said what? He’s leaving you?). Spike him with benzos, we’ll forge a record that he is a patient (“active client”), and then obtain a police referral by planting a knife and some cannabis on him when he collapses. If were lucky police won’t shoot him and you can have him ‘assessed’ before you go on your holiday next week. Mind you these sorts of interventions tend to run into months of dribble therapy so maybe your new man can fill in for the holiday? Strange but people seem to react badly to being snatched out of their bed and thrown into a police van and dropped at a hospital for treatment when they don’t even have a doctor. All that blah blah I have human rights and this is torture, it’s medicine because were calling you a “patient” from this point on. But someone wants it done, and did invest $200 in a ‘therapy’ session so, ya get what ya pay for.

    I should have studied drama like my wife, and maybe I could turn on the tears and make people feel sorry for me when I want something done.

    7 hours of being locked in a cage with people who were being subjected to some vile abuse they call medicine, interrogated and not being informed that you have been ‘spiked’ is not what i’d call a good ‘product’. But then again, i’m the one who hasn’t seen my grandkids for 9 years and had to live on the street until I walked in front on a truck. And all this because I disagreed with my wife. And I must say that the slander is very effectively used by our current Minister, anyone who disagrees with him is in obvious need of some ‘product’. Even I can hear that dog whistle Minister.

    But I get where your coming from.

    • Actually, this ‘product’ (and I did get the whole package for just $200 inc.) was good value really. I mean when I look back I realize that I was subjected to that 7 hours of interrogation whilst ‘hallucinating’ from the benzos (i’ve never taken these drugs before and was given 4 times the amount given by Dr Kearsley to his victim which he did 2 years prison for but). What is really interesting is I was released by the psychiatrist who could find “no evidence” of a mental illness, and yet my wife was able to go round all my friends and family and slander me rotten. “oh he’s been in a mental institution only last week” to all the people at the Cricket Club. “oh he’s been acting a bit strange since being released from the mental institution, it must be his illness returning”.

      Great value that $200, and not a soul will stand up and say you know what, that’s wrong.

      It should be criminal, oh wait, it is. It’s just that police like having the ability to ‘spike’ people before interrogations and using their ‘coercive’ methods, makes the job much easier. Especially when you have people prepared to plant items on the target when they collapse from the ‘spiking’. So maybe not being able to find their copy of the Criminal Code isn’t just about a lack of resources? Might it be a benefit they obtain? Because the Community Nurse who received a referral from police, and knew I had been ‘spiked’ was quite happy to hand me over to them for further interrogation before they dropped me off for some dribble therapy.

      Terrible the things that are happening here in Libya since Muammar Ghadaffi was despatched. Oh wait, it’s Australia i’m in. They look so much alike to me these days.

      • Woops, let me just step over that dead one and move to someone with a positive story to tell about how therapy helped them………….. Was it Orwell who said Ignorance is Bliss?

        I guess the facts that this ‘therapist’ who did this to me (and by proxy my family) didn’t really like my anti psychiatry sentiments, her husband being a psychiatrist. So she saw an opportunity and put more than the boot in.

        I would be extremely careful sharing anything with these people. Let me say that when this all ‘blew up’ they went through my old records and released some very private and sensitive information which was taken out of context. Handed that confidential information over to ……anyone who would spread the slander.

        The person who documented that information (a social worker) did so completely without malice. But once they realized someone might listen to me about what had been done, then they went to town on me. 10 years on and that information was being used not for ‘therapy’ but to completely dismantle my life. “fuking destroy” me was the quote from the Operations Manager who dealt with the complaint.

        Weaponising I believe is the term for this type of conduct. And don’t think your going to get any assistance from police, there’s a symbiotic relationship going on there. Mental Health are service users of police with an running account. Rent a thug.

        Complaining to police about crimes committed by mental health services is like trying to complain about being raped by a football star. “We don’t have a copy of the Criminal Code in this Station”, and let me just make a call and have a nice doctor remove your human and civil rights. And the self regulating system means that such vicious attacks on ‘clients’ is put down to “character flaws” rather than what it really is, criminality.

        Might not have been Orwell, oh well, Trust in Haste, Regret at Leisure

  4. Another way to think about this, perhaps, is that we are all seeking control–what will happen to us and what other people think of us, for example. I’m an instructional coach at a large public high school, and part of my job is to help teachers relinquish control while guiding students to discovering ideas or answers or solutions themselves or with each other. I use this lens–giving up control–when I feel anxiety about someone or something. I have been working on two things–what is it I can control and what is it I can’t. I cannot control what people are thinking, as in the student in Hugh’s example, nor can I know what they are thinking. I can only be in conversation with other people, and I can only engage in my own ways.

    I don’t think this is easy. Part of what’s difficult for me is that I want certain things to happen, certain outcomes, certain reactions–certain things out of my control. Desire. That is a great obstacle. If I knew the answer, and if I could control the answer, I would feel calmer. I am learning that those things are impossible.

    • Garth, I think your awareness of wanting to control things (as we all do) is a great first step. Perhaps a next step is working on embracing, in your words, “I can only be in conversation with other people,” embracing creating “non-knowing and non-controlling” conversations with others in which you mutually explore your assumptions and opinions as a joint activity not focusing on the rightness or wrongness of what you and they are saying. I’ll be eager to hear how that’s going. Thanks so much for your comment.

  5. Greatly enjoyed Hugh’s (my college roommate) and Ann’s latest blog – really resonated with me. In my own career as a physician, I had to try hard not to let my “knowledge” lead to a rush to judgment, thus getting in the way of truly listening to my patents and short-circuiting a potentially more revealing and productive discussion. Indeed, their blog reminded me of several unfortunate occasions when I either missed or was delayed in making the correct diagnosis because I failed to listen to what my patients were telling me!
    Chaz Brendler

  6. Anne and Hugh, Thank you for sharing this lovely conversation. It embodies the way that you must practice as therapists and gives expression to the value and excitement of being curious about rather than assuming that you know what’s going on and what to do about it. And that your role is supporting everyone in your groups to perform in that way.

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