What do you do when a therapy session you’re conducting goes very badly? If you’re like me, you imagine what other therapists might do. I might say to myself:
I wonder what Carl Rogers would do. Probably sit on the edge of his chair and beam acceptance—as he did in that film with Gloria. That’d be good, but whenever I act like Carl Rogers, it comes out phony.
I would have temporarily given up trust in my own instincts and my own theory. I’d think, as a colleague described herself as doing, “What would a real therapist do here?” In my book, After the Fight, published in 1993, I described various therapeutic approaches I’d consider at such a moment:
I know what a strategic therapist would do: prescribe the symptom—recommend that Stan start a fight with Joyce every day next week—although when I tried something like that last month, it didn’t go well.
I know what a cognitive therapist would do: challenge the client’s negative self-talk. What a marvelous term—“negative self talk.” It really captures something. Whoever invented it deserves a medal. Who was it, anyway? Donald Meichenbaum?”
I don’t know what Milton Erickson would do. He almost always comes up with something that would never occur to me. So I might as well not even try to think about it.
Jeffrey Masson says the only really good therapists are warm older women. My client should be seeing a warm older woman. Given how I feel at the moment, maybe I should, too.
That was 20 years ago. A new set of theorists has arisen on the scene. So now when a couple therapy session is going badly, I think:
I wonder what John Gottman would do. He’d tell the partners about the damaging effect of contempt. And he’d have already built up the couple’s friendship so they’d be better able to deal with this fight. I’ve got to dig up the forms he uses for doing that. I’ve got them somewhere.
I know what Sue Johnson would do: speak in a soft voice and uncover the attachment fears at the root of this fight. And she’d sit closer to the couple. Okay, I can do that. And she’d put her hand on the knee of one of them. I can’t do that.
I know what Harville Hendrix and Jim Keim and Stan Tatkin might do: ask one of the partners to put their head on the other’s lap. That could turn things around. But that’s too big a leap from who I am.
I could ask the miracle question. That’s always a good idea. I could say, “If you woke up one morning and by some miracle your problems were solved, how would you know? What would be different?” Who was it that came up with that? Was it Steve Deshazer? Or was it Insoo Berg?
Terry Real would have taken charge from the beginning. He’d challenge the partner he saw being more unreasonable. He wouldn’t put up with any of this. At the moment, I wish I had his temperament—and his theory—so I could do what he does.
I know what Michael White would do: ask those amazing questions that would raise the couple’s spirits. I remember the videotape of a couple where he asked, “Who would be the first person you’d want to tell about how you’ve reclaimed your marriage?” How does he come up with such questions? It would take me forever to learn how to do it.
Ellyn Bader & Peter Pearson would get the partners to ask questions of each other. I’ve got to learn how they do it. And they’d get the partners to take personal responsibility.
Which David Schnarch would do, also. And he’d get them to self-soothe. At the moment, I could use a bit of self-soothing myself.
I wonder if every therapist goes through such thinking. I have a colleague who probably doesn’t. We went to a party where we didn’t know anyone. I became self-conscious for not being able to break into conversations. He said, “This is a boring party. Let’s get out of here.” I don’t think he’d ever become self-critical when a therapy session went badly.
Nor would a certain type of person an historian friend told me about. He described a civilization that had fallen into decline. One set of people from that culture said, “Where did we go wrong?” Another set said, “Who did this to us?”
What do I do when, as a therapist, I feel, “Where did I go wrong?”
I step back and empathize with myself for being in a panic: to look at myself being in a panic from a calm perspective.
I tell myself, “I’m having a low moment”—by which I mean it’s just a moment and soon there are going to be better moments.
I remind myself of the Buddhist perspective of watching the various moods and feelings passing through me.
I remind myself to do for myself what I help couples do—step back and view themselves from a wider, wiser, calmer, gentler perspective.
Dan,
Thank you so much for this. What you described is so common, and sooooo human.
I love comparisons of what various therapists would do in the same situation. Maybe someone should do a version of “Three Approaches to Couples Counseling”–similar to Carl Rogers’ “Three Approaches to Psychotherapy” where he, Perls, & Ellis worked with Gloria. At any rate, thank you for your vulnerable and insightful blogs. I always find them fascinating and so enjoyable.
Whew! What a relief to see that even the amazing Dan Wile has self-critical moments!
I ask myself; what would Dan Wile do?
Gotta love it.
Just received “After the Fight” in the mail. I’ve used Collaborative Couples Therapy for years. Funny how once you have something of a platform you don’t need to defend the fort so intensely.
Many thanks for your sharp analyses and personal honesty.
What timing! Just what I needed this week.
You remind us that having empathy for ourselves is the first step toward having empathy for our couples (and individuals).
I also especially liked the historian’s example: Where did we go wrong? vs. Who did this to us? Hmmm. I might just use that!
Thanks, Dan, for your incomparable thoughtfulness!!
I agree and echo Elsa’s comment. Some days I do run through all the therapists names I know ( my colleagues) and their work. So if you compare yourself to other therapists, then darn it I can too.
Thanks for the encouragement.
I’m chuckling as I read this, since last week I had a very self-critical moment (hour?) after seeing a couple for the first time. I knew I was going to see the husband this week to take his history, since I’d already seen the wife alone one time before seeing the couple. I wondered how the heck I was going to have any empathy for this guy, who I’d already seen as a big, alcoholic jerk.
Thank God I have a peer supervision group where each week, for the past 22, we’ve met to talk each other down, and re-assure one another that we, in fact, do have skills. I’m also fortunate to have several (non-judgmental) colleagues, who can laugh and assure me that they have felt the same at times. It helps me know that (as you said) these are moments, and they can pass when we put them (with the help of others) in perspective.
Thanks for the fabulous and very honest posting, Dan.
One more thought: couples counseling experts sometimes appear so divergent in their approaches/styles that I sometimes wonder if the effective underlying components of any couples therapy approach are the same.” Bruce Ecker (Coherence Therapy) makes a case for universal underlying factors underlying successful individual psychotherapy, giving examples within EMDR, IFS, EFT, and others. I wonder if a similar “universal factors” case can be made for couples therapy. It is sometimes disconcerting read of sensational therapeutic outcomes resulting from such divergent & even contradictory approaches & styles. Oh, how I would love to read more writing like yours re: a cogent comparisons of approaches.
I like that blog so much – love how you go through all
these different people in your head then come out with
an accepting frame of mind. I’m eager to hear about
the responses people have. I imagine they’d be happy
to read this.
Thanks Dan for showing your hand. As you pointed out, while there are any number of “rules of thumb”, they only work on the hand from whence they come.”
Bruce
This is brilliant, Dan. Not only is it a coherent amalgamation of all the various theorists we’ve studied and tried to emulate or incorporate over the years, it is also a very soothing and reassuring view of our own self-doubts when working with difficult couples – that we are present, in the room, involved, and doing our utmost to be of assistance, even if sometimes we falter or doubt. Thank you for this welcome addition to a great storehouse of wisdom that is found in every newsletter you so generously share.
“Being stuck” is an unfortunate view of where you (and others) are holding at some point in time/
My response to my own”‘negative self-talk” (you’re right, Dan–it’s great phrase) in a classroom or after a particularly weak public lecture in which I define myself as having been boring or ineffective (or for that matter in a personal, intersubjective gaffe) is to try to see the failure as a virtue, as something from which I can learn. What I learn–or at least tell myself that I’ve learned–is that my screw up is not the end of the world, that one can forgive oneself, fail and fail again and perhaps do better next time–or the time after next. Or as Samuel Beckett has it, “Fail, Fail again, Fail better.”.
So gentle! And a reminder that we gravitate toward an approach not because it’s better than all the other approaches, but because it suits our temperament, strengths and limitations.
Although truthfully, Dan, if I had a session that went very badly, none of your self-soothing techniques would work for me at all, and I don’t think that would have anything to do with unreliable self-love as Bernard Apfelbaum suggests. I would only feel better after 1) figuring out what I should and could have done differently; 2) figuring out what to do to fix it next time, and 3) actually fixing it in the next session(s). Until then, I’d have no peace with regard to the bad session, and my distress would be roughly proportional to how bad I thought it was or what damage I felt I’d done.
Thank you, Dan! Your post has lifted my spirits. I think of you and your work often when I think about working with couples, and now, when I have those low moments, I’ll think of you again. 🙂
I love how you remain true to yourself throughout your comparative review …
Diane
Dan has opened up an issue that may very well close behind him: how therapists feel about their work and about each other. Not only that, he’s funny. He gently skewers other therapists, adopting the pose of an innocent who just can’t manage to act the way they do. When he says that he just can’t bring himself put his hand a partner’s knee or have one partner put his/her head in the other’s lap, he is certainly not saying this is a problem he is working on. And when he says that he might emulate them if he is wasn’t always losing track of his copies of their stock answers, that obviously is a clever jibe. More to the point, and unique to Dan, he talks about how these solutions make him feel, and you can’t argue with that.
Also, and especially unique to Dan, he discusses how he copes with “negative self talk” following a bad session, taking a moment to appreciate having that phrase as handy way to package the experience. Before it was coined, you would have to describe the experience each time you referred to it. “Self talk” is itself especially valuable. It acknowledges that we are always in a dialogue with ourselves, that our “I” is actually a “we.” Negative self talk is the expression of a relationship, but as the phrase is invariably used, it suggests no more than negative chatter. Chatter that needs to be combatted, revised. It is as if it doesn’t come from anywhere.
In Dan’s prototypic example he uses a variety of refutations to argue that he deserves a break, that one bad session is not the end of the world. It can easily seem like he is just having to ward off unfair and intemperate attacks, not arguing with anybody, much less struggling with a harsh self-relationship, one in which forgiveness is hard won, in which the only way you can get a break is by arguing for it. In the typical case, at least, (I’m obviously not talking about Dan himself here) this would mean that you can be at risk for losing the love of your inner authorities. You can’t be secure in the belief that they love you even when you screw up. There is no comfort. You are being frowned on, or worse. Dan marvels at therapists who seem immune to that experience, seemingly expert at self-justification.
If you felt that you will still be loved you could just feel bad about letting your patients down; you might even feel sorry for them. In other words, what refutations overlook is the harsh inner relationship that negative self talk expresses.
And here’s another relevant quote, Dan–Bessie Smith’s “One ain’t for always/And two ain’t but twice.” That is, “one ain’t for always” is to remind oneself that to have done what we ought to have done is no assurance that we will do it right again the next time we ought, and “two ain’t but twice” that to screw up, to have left undone what we ought to have done, is no condemnation to the leaving of all future oughts undone.
Dan: As CCT is based in ego-analysis, I thought it might be interesting to think “What would an ego analyst do with the feeling ‘Where did I go wrong?’” Being an ego analyst myself, I thought I might reflect on whether “the need to not understand” was operating in me (Apfelbaum, Bernard, On Entitlement to Feelings, website article). Specifically, in the session, was I feeling that I was losing my therapeutic leverage–and that caused me to miss the client? In other words, was the client challenging me to understand them in a way unfamiliar to the way I normally think—so that I was avoiding understanding them for fear that I would over-identify with them, risking a critical loss as a therapist, the loss of an independent point of view? If so, it would be good for me to go back to the original statements made by the client, and the symptoms presented—and think that symptoms, and what our client’s say about them, are in no way arbitrarily chosen and, if carefully analyzed, can lead us to developing what is really going on with this client.
Dan: I enjoyed your review of famous therapists. Yes, I think about you when I feel myself falter–like I should think about your platform and be a guide as you are. It is also nice to see your sense of humor, sometimes I am too intense and feel it is important to lighten up—and not be overly serious all the time.
When I have moments in my life/practice that I question being off with clients/patients, I usually talk to myself about stepping back/sitting back and letting anxiety dissapate through breathing. When I bump into the anxiety of questioning myself, it usually indicates I am doing the work for the client/patient— to step back and let go of taking all the responsibility. I consider it a reaction to the client’patient feeling out of step and catching their feelings. Then, as I sit with it, it starts to move forward and into the realm of recovery and the energy shifts towards the client/patient. Thank you for broaching our human side so delicately with great humor!
Dan, and everyone who posted, great topic. Here is my stance on a “good” session vs. “BAD” session. I usually click my heels after the session and say “Great session today” I am a great therapist!!! The later is usually, I should have been a plumber instead!,Yikes!!! I then ponder where I went wrong, then kick myself several times before I recover. Thank Goodness, everyone survive LOL Edie:))
Reading this gave my colleague and I such a laugh – reading how you captured each theorist’s approach and the warm playful reflection you had on what they would do and your response to this. We’d also previously wondered what would happen if we dared touch the client’s knee like Sue Johnson!!
Thanks for your warm, witty, generous and practical newsletters – I really enjoy them and pass them on to others. They really help me focus the way I work and what I am doing.