Friday, March 9, 2018

A View from the Other Side of the Couch

A Gift of Cuban Oregano
Psychotherapy is hard. I do not mean that it is hard because a patient must relive painful and often times repressed childhood memories. We all know that this is hard.
No, what I mean is that it is hard being a patient. Fulfilling the role of patient is hard.  Managing the emotional investment required to “co-create” an effective therapeutic relationship is taxing and, frankly, scary.  My role as a patient is to allow myself to form a potentially one-sided emotional bond with a person I don’t even know. I don’t really know who this person is that I am trusting with my most intimate thoughts and deepest fears.   I have to form an intense emotional bond with a person who, when it comes right down to it, is only there because I pay her. I don’t know who she is. I don’t know where she goes after work, I don’t know where she lives, I’ve never been to her house, I’ve never met her husband or kids, I’ve never talked to her outside her office.   And yet I trust her implicitly. I have to. How else is therapy possible unless you don’t throw caution to the wind, close your eyes, and blindly jump? And so I have. But this is emotionally challenging. It is hard. It can be draining.
The challenge is to honor the trust.  It is a challenge because it is a trust that can’t be tested and reaffirmed in ways that trust in other relationships can be.  I can’t call her up to see if she wants to chat. I can’t drop by her house for a visit. I can’t ask her to meet for coffee. I can’t do the things that in a normal relationship would be incremental tests of whether my emotional investment is reciprocated.  I have to trust. And to keep the therapy vital, I have to honor that trust.
This is the odd thing about a therapeutic relationship.  A patient (i.e., me) has to demonstrate his respect and caring and love for his therapist by not doing the things that you would do in any other kind of relationship.  In most relationships care is demonstrated by doing; in a therapeutic relationship it is demonstrated by not doing.  Herein lies the stress.  I am bursting with care and love for my therapist, but I can’t demonstrate it.  At best, I show respect by staying within the confines of the boundaries that therapeutic technique and professional ethics require.  Most demonstrations of caring are therefore somewhat invisible. I show up on time, I don’t cancel appointments, I pay my bill. In short, I demonstrate my caring by being a good patient.
But this is unsatisfying.  In all the great relationships in art and literature, none are based on such mundane demonstrations of affection.  Romeo and Juliet did not sacrifice themselves on the altar of arriving at scheduled appointments on time. Elizabeth Barrett Browning did not count paying bills on time amongst the ways she loved thee.  Pythias did not demonstrate his friendship with Damon by staying away.
Ultimately, patients have the need to offer tangible demonstrations.  Giving gifts is one way of doing this. But what kinds of gifts are appropriate for a therapeutic relationship?  Even deciding this can be stressful. I would like to give my therapist something to show my affection, but I want to show my respect by staying within the boundaries.  It can’t be too expensive or too romantic or too intimate or too anything. So what kind of gift is right for the relationship without it being so trivial it’s meaningless?
I decided on a small plant.
I have been growing a Cuban oregano plant on the window sill in my kitchen for a number of years.   When it grows too big for the little pot it’s growing in, I snip off the overhanging vine and stick the cutting into another pot.  In this way, I have come to have multiple pots crowding my window sill. It occurred to me that maybe one of these plants would be an OK gift.  It seemed appropriate. It was by no means an expensive gift. The little terracotta pot probably cost less than a few dollars, the Cuban oregano was propagated from a plant I already had and which I had an excess of.  From a purely economic perspective it didn’t seem valuable enough that it would create any uncomfortable expectation of reciprocity. It just seemed like a nice little gift. She has other plants in her office and it seemed like it would fit in.  Plus, it had the added benefit of being something that I had cared for and nurtured rather than some cheap gift I bought off the shelf. Whether she would perceive it or not, it had meaning to me.
But because it had meaning for me, I hesitated.  I deliberated on whether it really was appropriate and whether it was honoring the trust, or whether she would in fact see that it had meaning to me and therefore see it as an attempt to push boundaries.  Maybe, I feared, she would see it as an attempt to make the therapeutic relationship into something else. I worried that it would put her in the awkward situation of having to reject my gift and then having to work to put the relationship back on track.  I was worried about the emotional stress she would be forced to endure if this were the case. Consequently, I didn’t give her the Cuban oregano and simply took on the emotional stress of wanting to give it to her, but not doing so. I absorbed the stress and I fretted.
Finally, though, I decided to go ahead take the risk.  I reasoned that we—my therapist and I—have weathered “ruptures” in our therapeutic relationship before and have come out of them with an even stronger therapeutic alliance.  So even if the gift turned out to be inappropriate, it would be something we would discuss together and work through. It would simply be another therapeutic opportunity. In fact, I reasoned, to hold back now would not be honoring the trust.  Thinking about giving the gift was causing me emotional distress and emotional distress is precisely what therapy is all about. At this point, therefore, I was therapeutically obligated to take the gift to her. So I did.
She loved it.  She took it for exactly what it was—a gift of little economic value, but immense symbolic value.  It was a gift that symbolized my wish to express an emotion while simultaneously doing so without violating the boundaries of therapy.  With embarrassing clarity, she told me that she saw it is a part of me that I have left in her care to nurture and grow. I was pleased.
No, I was relieved. In fact, I was so relieved that she did not reject the gift that I failed to understand that she really did like it.  It took a number of days before it sunk in that she actually liked it and I had to wait until our next session to confirm that I had understood correctly.  Then it took a couple of more sessions to understand why I didn’t understand that she liked the gift. In the end, it was a therapeutic opportunity after all.  I gained insight into my anxieties, our therapeutic relationship, and my relationship to that relationship.
I’m not sure this has made being a patient any easier, though. I still want to honor the trust, I still want her to know I care, I still want to stay within the boundaries of a therapeutic relationship, and I still struggle to maintain the balance between these goals.  It can be a difficult emotional balance. I wonder if therapists know how difficult it is to be a patient. I wonder if my therapist knows. I wonder if I should tell her. I wonder if I should let her read this essay. I wonder how she would interpret it. What if she takes it the wrong way?
Psychotherapy is hard.

-Tom Ford

1 comment:

Anonymous said...

What a wonderful essay!! It captures the angst and joys of the relationship between patient and therapist. This piece was really enjoyable to read. Thanks Tom Ford!