Is your therapist a "good" therapist? How do you know? Is it that you always feel better after seeing her? Is it that he makes you feel safe and secure? In this episode of Plain Talk about Talk Therapy, we're going to explore how to know if your therapist is the right therapist for you. Or the wrong therapist. Do you think you know how to tell already? Let's find out.
Is Your Therapist a Good Therapist?
One of the earliest pieces of advice I got as a therapist was, if all the therapists on staff were arguing as to whether a particular client was getting better or not, then the client was probably a borderline (a severely disordered person). Oddly, no one ever offered me advice as to how to tell if a therapist was sane or not. Or even effective. Perhaps this is why it has taken me so long to formulate my own way of knowing whether a therapist is good or not. Even now, there is much for which I have yet to find the words.
Disclaimers aside, let's begin this week by exploring a few of my personal guidelines. Know they apply mostly to therapists who work with normal folks (as opposed to those who work with severely disordered folks).
So what makes "good therapists" good?
- Good therapists sit at the same level as their clients. Poor therapists sit above them.
- Good therapists take up space in the room. Poor therapists take up no space. Or all the space.
- Good therapists cry with their clients. Poor therapists cry for their clients.
- Good therapists respect the needs of both themselves and their clients. Poor therapists have no needs.
- Good therapists reveal their faults and make mistakes. Poor therapists hide or deny them.
- Good therapists risk fights in the service of healing. Poor therapists don't, can't, or won't risk a fight.
- Good therapists are always growing, both professionally and personally. Poor therapists haven't self discovered in years.
In a moment, we'll explore these seven guidelines, one at a time. Before we do though, I need to preface our discussion with a few basics from Emergence Personality Theory. Two, in fact.
The first, pictured in the diagram above, is the event from which all of personality stems. It is also the single experience we humans have in common regardless of culture and ethnicity; the Birth Separation Moment.
The second is the first aspect of personality wherein we begin to differentiate from each other. The yin and yang of all human relationships. The give and take of personality; the Four Character Types.
Let's start with the Birth Separation Moment.
Emergence Personality Theory sees personality as comprised of a nested set, and subsets, of fractals. A nested set of recognizable patterns which always repeat differently. Moreover, the theory describes these nested fractals as organizing around a single strange attractor; the sequence of three events we experience in the moment in which we physically separate from our mothers.
I call this event, the Birth Separation Moment. Not that what happens prior this event has no affect on personality. It's just that before this moment, everything we experience, we experience with someone. Not as two separate beings but rather as two beings that are one being. In the most intimate human relationship we will ever know.
Literally then, before birth we live in a kind of experiential Garden of Eden. In a marriage of soul mates. In a suspended state of seemingly permanent togetherness. In this state, we face whatever life throws at us with an ever present partner in an ideal kind of intimacy. Connection at its finest. At least for us humans.
Am I being too philosophical? Sorry. What I'm saying here is that, before we physically separate from our mothers, we live life as an ongoing "co experience." As if we are joined to another at the psycho spiritual hip, so to speak. In effect, it is as if we were conceived married. Can you imagine? We physically occupied the same space and time as another human being with not a single moment of having to face our needs alone. Not a one.
Hungry? We ate the same food.
Tired? We slept the same sleep.
Cold or hot? We shared the same blanket. And felt the same sounds. And suffered the same illnesses.
My point? Before we experienced the Birth Separation Moment, we had yet to know what it was like to face a need alone. Not even for a single moment. Not even for the blink of an eye.
Then it happened. With no forewarning (at least none baby humans could possibly grasp), we were forcibly expelled from this Eden-like state of perpetual togetherness. Within seconds then, and for the first time, we had to face life alone. With no instructions and no time outs. Needy. Scared. Blind. And hungry.
Underlying this event is the simple sequence of three experiential states from which all human personality forms. This sequence roughly comprises our three most personal human experiences;  the experience of connection (to others and to our world),  the experience of aloneness (the experience of disconnecting from these connections), and  the experience of need (our natural response to these disconnections).
What makes this sequence so significant is that it then becomes the experiential pattern for any and all events which injure us, regardless of the nature of the symptoms; connection, disconnection, and neediness.
In a very real way then, we could say that all human injury, including everything we explore in talk therapy, is a reliving of this Birth Separation Moment fractal pattern; connection, disconnection, and neediness. Admittedly, there's a lot to discuss here. Including why the nesting numbers begin with ten and not one. Know we'll talk a lot more about this fractal sequence in coming episodes. Including why it injures us and how it reveals the pattern beneath all healing events.
As for Character Types, the second of these two sets of fractal patterns, they are the four possible strategies with which we try to satisfy needs. Ours and everyone else's. These four strategies are;  facing neediness as a Me (I only see my needs; you need to meet my needs),  facing neediness as a You (I only see your needs; I need to give to you),  facing neediness as a Me then You (at first, I only see my needs and then I only see your needs), and  facing neediness as a You then Me (at first, I only see your needs and then I only see my needs).
Know we are all born with strategy One as our default way of facing neediness. We all cry out, "what about me!" whenever we feel needy. By age four though, nature divides us into four separate groups, each of us having been assigned one of these four strategies as our default way of responding to feeling needy.
Where do these four patterns play out in our lives? Mostly, within our relationships. However, because we humans are social creatures, they also affect pretty much everything else we do as well, from who we seek help from and or blame for our suffering to whom we fall in love with and or pick to be our friends.
Here again, we'll take a more in depth look at these four strategies in future episodes. For now, it is only important to know that these two fractal patterns comprise the two most basic aspects of human personality. The first is our common heritage; the Birth Separation Moment. The second is our most basic difference; the Four Character Types.
Moreover, because all human beings, including all clients in talk therapy and certainly all talk therapists, have personalities based on these two fractal patterns, the heart and soul of doing therapy lies in learning to recognize these patterns. Moreover, to deny this common heritage of vulnerability is to deny our very humanity.
Sadly, many talk therapies expect therapists to do this very thing; to deny and even hide these aspects of themselves. Certainly their neediness. And often, their wounds. In fact, most talk therapists are expected to act as if they have, by virtue of their education and training, risen above these human frailties.
No therapist is exempt from these vulnerabilities of the human condition. Nor is it healthy to even attempt to deny or rise above these parts of our nature. Unfortunately, much of bad talk therapy focuses on teaching people how to ignore, or at least, work around these human frailties. Conversely, honestly acknowledging these aspects of ourselves is the basis of all good therapy, regardless of technique.
With this in mind, let us now explore my seven guidelines. Remember, these guidelines are only a starting point.
Seven "Good Therapist" Guidelines
Good therapists sit at the same level as their clients. Poor therapists sit above them.
I once had a therapist tell me in the first session that if I followed all her instructions, I'd have a happy life. Can you imagine. This despite the fact that she had some pretty glaring problems not the least of which was her sense of superiority.
I also once had a therapist tell me, in a first session of couples therapy, that she had never liked using condoms. This from a woman who was many years my senior, a classy professional, and a heck of a human being besides.
Guess which therapist I did better with. Obviously, this is a no brainer. And while I admit therapists need to know things their clients may never need to know, they had also better not forget where this learning came from; from their having faced their own painful shortcomings. As human beings. Not as therapists.
Good therapists are people first, therapists second. Anything less is simply a false wall of superiority covering up the therapist's insecurities and lack of professional skill. Not exactly the kind of person a client should open up to, let alone trust.
Good therapists take up space in the room. Poor therapists take up no space. Or all the space.
I can't tell you how many times I've argued with otherwise wonderful therapists as to how wrong it is for a therapist to take up no space in a room. Translation. These folks think 'tis better to give than to receive means not having needs in front of a client. Oddly, they never remark on how having no needs in front of their clients inhibits their clients' willingness to admit and face their needs. Let alone how this can add to their clients feeling ashamed and defective when they think they are "the only ones with problems."
Know this guideline does not apply to therapists who work with severely mentally ill folks. Why not? Because the essential nature of mental illness is that these people are incapable of seeing the needs of others. They can see only their own needs. This, in fact, is what makes helping mentally ill people so hard. And draining for healthy therapists. These folks literally cannot see how their behavior affects others. Certainly not the therapist. Thus they rarely come to genuine insight about what they are like in personal relationships.
In truth, no one gains insight let alone heals their flaws without first seeing themselves through another's eyes. This kind of mirroring, in fact, is the very essence of a good talk therapy. And for a therapist to do it, they must take up space in the room.
What does taking up space look like? When a client insults you, you tell them, including your hurt and angry feelings. Blamelessly of course. But honestly and without watering it down with excuses. And when a client asks you a personal question, you answer briefly but authentically, similarly to how the therapist I mentioned above shared her dislike of condoms.
As for how Emergence Personality Theory applies here, no decent therapist can possibly be a Character Type, "One." Or as we sometimes refer to them, a Character Type "Me," meaning, a "first year of life person." Why not? Because a One is incapable of seeing, let alone responding to, the needs of anyone but themselves. Thus they cannot understand why a therapist would need to use healthy mirroring and so, no real therapy can happen. At least none initiated by the therapist.
Know I make this disclaimer as I once was in therapy for over a year with a therapist who was a "One." To my credit or more accurately, by some miracle, I grew anyway. Mainly from my having confronted her on things like the following:
She once said to me, "I bet you were at the top of your class in your Masters program. Well, in a doctoral program, you'd be nothing special." I hadn't done anything to initiate this line of discussion. She simply felt like humiliating me.
Another time I came in tearful. I had just been hugged and told by a seventy year old, long time client that he loved me. When I told her this, she replied, "That's not love. That's only transference." I guess to her no client can ever love their therapist. And no therapist should ever see these displays as genuinely warm and human. Even knowing better, I still felt ashamed and full of self doubt.
And another time she said that if I quit therapy with her that she'd feel sorry for my clients.
Two years later, when I began writing Emergence Personality Theory, I realized the essence of a real therapy is blamelessness. Not excuses, mind you. There is no excuse for a therapist like her. There is, however, a real part of human nature which blamelessly reveals the nature of her difficulty. This nature? She was a Character Type, "One." Translation. She saw only her own needs and none of the needs of her clients. She, in fact, literally demanded all the space in the room. Moreover, whenever I tried to take up space in the room, she punished me with meanness and spiteful remarks such as those I've just mentioned. Which, of course, made me feel small and insignificant. Not exactly the best way for a therapist to help someone improve their self worth. Some therapy, eh?
Good therapists cry with their clients. Poor therapists cry for their clients.
I have always cried with my clients. And for myself. Which is the same thing if you know what crying with someone means. If not, allow me to try to give you the gist of what I am saying.
Compassion is the core skill needed to be a therapist. Compassion comes only from facing and healing one's own suffering. Including that you come to forgive yourself for having been injured in the first place.
Tears are the best evidence that you've healed and forgiven. Not sobbing, mind you. Sobbing means the healing is still in progress. But tears. Good old fashioned wet eyes, streaked cheeks, and sniffling noses.
When a client begins to heal, I always begin to cry. With them. And for me. Both of us flawed but courageously healing human beings.
They know when it's with them too. And so does everyone else. How? Because crying with someone feels wonderful. Crying for someone feels terrible and alone.
Therapists, please, do not leave your clients alone in their sadness. Cry with them. Or at least begin to work on whatever prevents you from crying with them. As I've said, compassion is the core skill needed to be a therapist. And clients, please, do not overlook this very necessary part of being in therapy; that someone both witnesses your suffering and resonates with you in it. Why not? Your very healing depends on this happening.
Good therapists respect the needs of both themselves and their clients. Poor therapists have no needs.
In my early years as a therapist, I used to excuse any and all things clients did to me. As best I could, anyway.
I also accepted anyone who showed up at my door. And blamed myself without mercy for any and all failures in the therapy.
Today I choose clients based mostly on how open they are to learning about human nature. As well as on their having a genuine ability to respect my efforts as a therapist and me as a human being.
I of course do not expect them to always agree with me. Nor that they will never get mad at me. In fact, some of my best moments as a therapist have been when a previously mousy client roared back at me for the first time, then saw my smile, then warmed to the soul. In those times, laughter is truly the best proof of healing. Better yet if it brings tears of joy to your eyes.
I guess what I'm saying is, I love when people come into their power. And I love people who admire and respect my power as well. Two powerful people in fact have the ability to change the world. Certainly the world in which the therapy is conducted. And definitely the world in which these two people live.
In a way then it all comes down to that respect is never too mousy nor too brassy but is always powerful and alive with smiles and tears. This is the respect to which I am referring.
This is also the respect to which a healthy person aspires. And wants for others as well.
Good therapists reveal their faults and make mistakes. Poor therapists hide or deny having them.
I cannot remember a client in years to whom I have not admitted my faults. I do remember once in my first year as a therapist denying that I was angry at a client. This occurred during a sequence of four full days of multifamily group therapy. At the time, I was working as a family therapist in an adolescent rehab. Late in the day of the second day of group, I denied being angry at a family member. The next day as I began day three's group, I admitted to this man I had lied. Which probably did more to change this man's life, and mine, than any other part of what happened in therapy that week.
Since then, as a therapist, I frequently tell stories in which I fail, err, and keep trying. To me, this kind of sharing is the lingua franca of a trusting relationship. I in fact frequently tell my clients that I will not ask them to tell me anything I am not willing to have them ask me. And while this quality does tend to freak out mentally ill folks and insecure therapists, healthy folks tell me this is one of the main reasons they trust me. I, like them, am an openly-human being. Still growing. And still learning.
What I am saying here then is that there are times when self disclosure is good. Know the reverse is true as well. What I'm saying is, learning to build trust without using self disclosure is probably one of the more important skills a therapist could ever develop. I was taught this lesson in a brief lunchtime conversation I had one day in that very same rehab. At the time, I was sharing a table with the clinical director for the adult patients and had asked her what she thought of self disclosure. At first, she was simply silent and I wondered if she'd heard me. But then she looked up and said; some folks believe recovering alcoholics make the best counselors; some believe non recovering therapists are less blind. Either way, she said, if I gained a client's trust by revealing either, while it would most times work and I would gain a client's trust quickly, doing this would prevent me from ever becoming a great therapist.
She was right. In one four full day multifamily sequence, I had a family member scream at me that I couldn't possibly know anything about alcoholism since I myself was not recovering. I am recovering. However, with the clinical director's words still ringing in my ears, I sucked it up and remained anonymous. A year later, when the family returned to the rehab for a reunion picnic, this man apologized to me and told me he had, to his embarrassment, heard me speak at an AA conference. I had not seen him there.
Here, I can see the proof certain that I healed something in me that day; I can still vividly picture the picnic tents pitched on the rehab lawn that day. And myself, as I walked away, in tears of reconciliation.
I have also never forgotten the woman who taught me this. She was, and still is, so right.
Good therapists risk fights in the service of healing. Poor therapists don't, can't, or won't risk a fight.
I cannot think of too many clients with whom I have not had a fight. Or at least a serious disagreement. I also cannot think of a single fight with a client which did not lead to a significant breakthrough. Unless, of course, the client quit. Which has happened on occasion.
When it has, I have always felt bad, then self examined, then asked myself how could I have done it better. Even so, I also know that to be too careful is to risk nothing, and that to risk nothing is to guarantee the status quo. I am a therapist, not a professional mommy. Thus if I think the moment requires a fight, I will risk doing this along with my income in the service of healing.
Why take these risks? It's simple. Helping people requires these risks. And as I often quote Rumi as saying, "Risk everything for love. If not, leave this gathering . . . ." Applied to therapists this means, "Risk loving your clients. If not, leave this profession."
As always, there's really no way to improve on what Rumi says. Thus there is probably not much more to say here.
Good therapists are always growing, both professionally and personally. Poor therapists haven't self discovered in years.
No therapist ever finishes their studies as a therapist. We are works in progress just the same as our clients are. I in fact learned this lesson from a therapist I once sat across from as well. At the time, I was in a very poor relationship with a mentally ill woman. I loved her. No apologies. I also had no chance of ever making this relationship work, and this therapist must have known this right from the first session. How can I know?
I once called her sobbing, desperately needy. At the time, I rarely if ever asked people for help. Even my therapist. Here again, I see the proof certain I healed then as I can still vividly picture what she said to me that day.
What did she say? She said that people like my fiancée do not get well. Better, maybe. But never well. I, myself, had never heard a therapist say anything this risky and honest. And while her words cut my heart like a knife, they were probably the beginning of me admitting what I knew all along was the truth. False hope had me bound to a painful relationship.
This same therapist was also the first professional to suggest to me I might make a good therapist. Imagine. At the time, I felt like the furthest thing from a healthy man anyone could be. And here she was suggesting I consider becoming a therapist.
What she said next was the part which has really stayed with me though. When she made this suggestion, I objected and said I was far too unhealthy to ever be a therapist. To which she replied, "You don't have to be done. You only have to be working on being done."
Here again, a therapist who was open and honest healed me and changed my life. Sadly, I was so self involved at the time that I cannot now bring to mind her name. Her love? Yes. But not her name.
We clients can be so self involved at times, can't we (smile).
This Episode's Session Notes
Obviously, we've barely scratched the surface as to what makes a good therapist good. In addition, some of the qualities of good therapists cannot be put into words. Even so, therapists who have these seven qualities have a strong foundation from which to practice talk therapy.
Why haven't I mentioned a therapist's healing skills? Perhaps because I see my seven guidelines as a good part of what makes a therapist able to heal. What is missing then? A lot actually.
For one thing, something we mentioned in the previous episode. Being able to consciously zero in on peoples' wounds. Which is why I've included this week's drawing; the Birth Separation Moment. This fractal pattern is what allows therapists to be able to zero in on peoples' wounds.
For another, being able to inspire confidence in mousy folks, and humility in brassy folks. The healing encouragements which lead people to claim their power.
And for another, being able to feel endlessly interested in learning about and from other peoples' lives. This is the heart and soul of being a therapist; genuine interest in other human beings. Which, as I said, precludes Emergence Personality Theory's, Character Type One's (folks who can see only their own needs) as therapists.
Is this it then? Have I covered the main things? Not really. And in fact, I've barely mentioned what I see as one of the main qualities a therapist needs have; the ability to make connecting to people more important that exchanging information. Not through mere niceness or being likable but rather through being open and real and warm. A genuine human being among human beings.
Here again, we see this portrayed in this episode's Russian Nesting Dolls diagram, yet another of Emergence Personality Theory's metaphors for personality. And to be honest, this idea is the main point. We begin at connection, and we should never forget this beginning. Even in therapy. And especially as therapists. In other words, learning to connect is always more important than learning information.
With this in mind, I hope we've begun to develop our own connection.
Until the next episode then.
I hope you are well,