THE CHALLENGE OF HONESTY IN PSYCHOTHERAPY

Subtitle: Honesty in psychotherapy is rigorous training for successful intimacy in life

Summary: Chip, in long standing couples therapy with his wife to improve sex and intimacy,  finds that painful honesty with their therapist facilitates great sex and intimacy at home.

 

                        “The establishment of an authentic relationship with patients,

 by its very nature,     demands that we forego the power 

                          of the triumvirate of magic, mystery, and authority.” 

 Irvin D. YalomThe Gift of Therapy: 

 

Chip looked concerned. Or was it perturbed?  In long term psychotherapy with me to strengthen personality dynamics created by an overbearing, professorial Father and a sweetly unassertive Mother, Chip has worked diligently to overcome his knee jerk tendency to appear mild mannered and polite at all times.  Chip has often found himself angry but was told, very early in his life,  to heed to the proverb, “if you can’t say anything nice, don’t say anything at all.”  

A  financially unsuccessful financial advisor with a high IQ, Chip has not been able to support his wife and family on his income alone, which creates tension in the couple.  Jocelyn, trained as a life coach, has supplemented their income, but the frenetic pace of rasing three children leaves precious little time for coupled relaxation. Hampered by Fibromyalgia that has left Jocelyn physically weak and in pain for long periods of time, many challenges face the couple daily.  Jocelyn is in pain much of each day. The pain can come at any time but is most frequent at times of emotional upset over one of the children or over Chip’s taciturn distance. “He gets so distant it scares me,” she said , looking wide eyed. I can’t imagine remaining so calm in the middle of a crisis. When I got to him for support he usually puts me off. “  

Chip realistically serves clients 365 days and evening each year, raises children, cares for a home, and is a model sibling to scattered brothers and sisters, but what feels so lonely for Jocelyn is that he prefers to remain quietly distant.  Far from unhappy about his lack of time to connect emotionally with his wife, Chip finds goal-directed tasks important.  “I show her that I love her by what I do, not what I say,” he reports with pride. To manage his need to remain polite and friendly to all at all times, Chip has had to restrict Jocelyn’s interchanges with him to topics that are safe and friendly.  If a child is sick he is a superb problem solver, seeing no need to delve into the emotional upheaval caused by handling the illness.  If money is lacking to pay monthly bills, he sees no advantage in discussing the concomitant anxiety that often accompanies chronic debt. “There is no value in discussing what can’t be changed,” he states matter of factly.

 

Chip’s purposeful strategy of erring on the side of tactfulness and good humor has robbed his marriage of the level of intensity and passion Jocelyn needs, so she asked him to join her in psychotherapy. Ever so reluctantly Chip began a course of therapy that created ongoing discomfort. Slowly and haltingly,  Jocelyn and Chip challenged the deeply differing assumptions between them: Jocelyn needed painful honesty and open discourse while Chip needed efficient task oriented problem solving. Thanks to their  good humor, they have made progress. Jocelyn, skilled in working with the origins of interpersonal distress, has pushed Chip to handle his remoteness, and has required that he examine the interpersonal roots in growing up in  a family that swept conflict under the rug to avoid being impolite with one another.

 

In the last three years Chip has politely attended therapy for 60 minutes monthly. He has usually begun the session with, “I really don’t have much to talk about today so Jocelyn can start,” replicating the marital pattern that leaves Jocelyn feeling frustrated and impatient. And, Jocelyn reports that  Chip , frustrated about spending money and time they do not have , states in private that the therapy is “not terribly helpful. ”But he says nothing in the session, honoring his early teaching , “If you can’t say something nice, don’t say anything at all.”  Because I am an authority figure he respects , the only avenue for Chip is to remain silent about his concerns and frustrations with the therapeutic process.

And, while I can appreciate his good intentions, it is important for him to speak honestly about his concerns with the relationship between us.   Far from favoring social politeness, depth oriented existential psychotherapy requests that the client face their fears head on and work honestly with the therapist to talk through difficult feelings.For proponents Dr. James Bugental and Dr. Irving  Yalom, the cultivation of presence is not didactic or theoretically abstract; it is instead experiential and concrete.   As a psychotherapist it is my job to help Chip tell me directly what he dislikes in our work.  As Dr  Bugental noted,  “(Psychotherapy)  does not just accept and encourage; it helps the client face the implicit and often unrecognized contradictions within his or her own outlook” Simply stated, if Chip is honest with himself and me, we can teach him to be more honest with Jocelyn. The therapy relationship usually mirrors the dynamics of a client’s life. Therefore, if a client can discuss the relationship I, as his  therapist, can help him move through a parallel dilemma in his life. By working with me, he can improve the marriage with Jocelyn. 

As it became clear that Chip was working in therapy with the same style he used in his marriage, I tried to engage him.  Despite decades of working directly with clients on their perceived and felt relationship with me, Chip’s way of remaining polite trumped all the interventions I could muster.  “Chip, how do you feel about the $300 charge last month?” “Chip, many might feel impatient if they attended sessions they did not find helpful. How about you?” “ “Chip, it benefits you to tell me how you feel about the work we are doing.  Please help me help you by giving me examples of ways I might help you more. ”  All interventions resulted in a pleasantly placid response such as “Some hours are better than others, of course. I am here because Jocelyn tells me to come. Without her I would use my time and money to other ends.”

The therapeutic impasse needed to be broken, a task we are accustomed to managing. Working out impasses in therapy is key in the treatment for clients.  If the location changes, if the elevator breaks, if snow prevents a group from meeting, the response to these events is discussed as key in  enabling the very change that clients seek. We  invite clients to tell us what works in their therapy and what they do not like.  We do this for two reasons: first, it informs us about how to shift our work to achieve best success for each client. At the same time, being honest in psychotherapy enables a client to work through the very hesitancy that has created their inability to effectively manage their lives. If a client can practice being honest with me, the client can more easily learn to be honest with the self and with the partner they love deeply.  As Freud and his countless intellectual offspring tell us, when a client enters into a deeply honest and self-revealing therapeutic relationship with a highly trained and skillful psychotherapist, the very dynamics that were key in forming the personality of the client come to bear in the relationship with the therapist. It is as if the client transfers earlier expectations involving trust or intimacy or sense of self worth onto the therapeutic relationship. Chip mirrors in therapy the polite distance with which he was raised in a family with too little time and too many burdens to risk learning to be emotionally honest with one another. The more  Chip and Jocelyn work out concerns from the family that raised them, the more benefit they can get from the therapeutic process. 

To help them, I initiated a conversation as part of their work.  I said, “Each time you honestly come to me with your concern about the therapeutic relationship,  you grow. So does the therapy. Each time you keep your deep concern about my character or my competence to yourself, the therapy and your ability to grow is disadvantaged by a block in trust.  As we go through tough things together, we prove to one another how trustworthy we are. When we hide how we feel, we leave a trail of doubt that the relationship is safe enough to warrant honesty, or we incorrectly decide that it is not wise to challenge an important event in a meaningful relationship. . Therapy is not social conversation. Therapy  provides  a template for how to be  honest with those who mean the most, creating  a path  through the toughest of life challenges without losing the closeness of your partner. When you engage me in an honest discussion of your concerns, then we grow as a therapeutic team. And, when you connect honestly with me,  you practice connecting courageously and honestly with those you love most.  How you relate to me is a practice ground for how to relate deeply and with passion to one another. “

My one word definition of intimacy is that intimacy equals  honesty. I am always appreciative of how a client feels regardless of how they feel.  As tricky as this  can be to uphold, it has proven as worth the endeavor as Dr. Yalom and the late Dr. Bugental describe. And if this can be true in professional psychotherapy, what might this stance do for you? 

 

To consider: Psychotherapy requires the tenacity and dedication to the self that enables optimal life choices. And is it worth it?  Those clients who build optimal lives as a result of their therapeutic work feel certain that it is worth every ounce of the work it entails .Do you?

To read: Publishers weekly interview with Dr Irving Yalom. 

 

Norris Clark