Therapy Part 2, the kind of therapist I am
What kind of therapist am I? There are many different kinds of “therapy.” There is “physical therapy,” “massage therapy,” “art therapy,” and the list goes on. Technically speaking (and I do not like this term because it is sounds so weird), I am a “psychotherapist.” Would you want to call yourself a “psychotherapist?” I am not a psychologist or a psychiatrist, but much of what I do is similar to some of the things they do. Unlike a psychiatrist, I cannot and do not prescribe medications. Unlike a psychologist, I do not administer psychological tests (I suppose I could if I wanted to, but I am not trained for it, and am not interested in it). Of course, not all psychiatrists prescribe medication and not all psychologists administer tests, and even those that do, don’t necessarily limit there activities to just these things.
So, I am back to “psychotherapist.” Yikes. Okay, well my professional background calls me a “Licensed Marriage and Family Therapist.” Some people think this means I am essentially a “marriage counselor.” Not true. Sure, I see married couples pretty often, but I don’t do “marriage counseling” with them (counselors give advice, and generally speaking I do not give advice, I ask questions that help clients find their own answers). I will discuss this distinction between “therapy” and “counseling” in more detail at some other point. Besides, although I am myself married, and I think marriage can be the basis and definition of a beautiful and deeply meaningful relationship, as long as the right to be married still in most places excludes some people who love each other and wish to be married, I find the word “marriage” in my license kind of offensive. At least it is legal here in Minnesota now. That’s something.
I could call myself a “family therapist.” Actually, this is what I usually say when someone asks, “what do you do (meaning, I suppose, “how do you pay your bills and spend your weekdays”)?” I say, “I am a family therapist.” Sometimes, the person who asked me what I do will give me a vaguely confused look, but seem to be more or less satisfied that I answered the question. Here’s the problem: while its true I am trained as a family therapist, and I do see families together, most of the time I see just one client at a time. This is not “family therapy.” It is “individual therapy.” The reasons I see mostly one client at a time are somewhat complicated, and have something to do with the way our society treats therapy as a medical intervention (which means insurance companies view therapy as treating something medically wrong with the individual I am seeing and it is my job to find out what is wrong with them and “fix” the problem). I go along with this because it is partly true—most of my clients do have serious problems they want to resolve in therapy—and because most of them couldn’t afford therapy unless insurance were willing to pay for most of it. So, I am a “family therapist” who sees some couples, some families, but mostly individuals. For the rest of this discussion, I will restrict my thoughts to how I view individual therapy and reserve for separate discussions how I view therapy with couples and therapy with families.
When I went to school to become a therapist, I had to decide, do I want to become a psychologist? A Licensed Clinical Social Worker? A Psychiatrist? Or a Licensed Marriage and Family Therapist? These were the four main kinds of credentials that would allow me to practice therapy in the widest possible venues (including being able to submit claims for my sessions with clients to their insurance companies). I decided on Licensed Marriage and Family Therapist in part because the basis for the “approach” or the philosophy behind it seemed to make the most sense in the context of “psychotherapy” (there’s that word again). Marriage and Family Therapy is a field that basically believes that the best way to help people achieve a psychologically and emotionally healthy way of living their lives is to incorporate how we function in our family relationships, or put another way, how well our families function as units, and how well we function within them. That’s a very broad and generalized statement, but seems to capture the gist of the underlying premise of Marriage and Family Therapy as a way of seeing therapy. Anyway, this seemed pretty legitimate to me. I just “made sense” to me. I mean, doesn’t it make sense? Its not the whole story of how well we function in our lives, but it seems to be a good starting point.
There are many different “schools” of family therapy, each with its own ideas of how to gauge whether a family is functioning well and how to apply different ideas and techniques in therapy to bring about changes toward more healthy functioning. I found some of these approaches and ideas helpful, some were bizarre, some seemed useless, some I still use today, after practicing therapy for over ten years, including family systems theories, narrative therapy, cognitive behavioral therapy (CBT), experiential therapy, existential therapy, and solution focused therapy. I still believe I made a good choice in deciding to become a family therapist for my credentials. It has served me and my clients well, but it is only a small part of what I have come to know is important for providing clients the help they need in therapy.
I am the kind of therapist who tends to be pretty engaged, talking a lot, asking a lot of questions, probing, curious, even directive when it is appropriate and might be helpful. This is just the kind of person I am. I am not going to and do not want to change this part of myself in order to be a therapist. That would be fake. And I would fail. I have participated in many sessions with clients in which I said almost nothing the entire session because during that particular session, the client needed to talk most of the time. If a client needed that to be the case during most of our sessions, that kind of therapy approach wouldn’t work for me, and so I wouldn’t be a good fit for that client.
If a client really doesn’t want the kind of approach that is consistent with who I am as a person, it is better for them, and for me, if they find someone who is more passive, quiet, taking a more reflective stance. This is why I am up front about this on my website, other marketing materials, and it is also pretty obvious right away when you meet me. I say things like “I tend to be more direct and proactive than most therapists….” How do I know this? Clients tell me this. They repeatedly tell me their previous therapist(s) were far more passive, mostly listening, encouraging, supportive, but not adding a lot or giving too much feedback. I make no judgments about this kind of approach. It is probably helpful in many cases. It just wouldn’t work for me. Fortunately, most clients who come to see me already know this from my materials so when they contact me they have probably decided this kind of approach is something that they think will be a good fit. On the other side of the equation, if a client doesn’t want, need or like this kind of approach, I will likely never hear from them because they see it in my marketing materials and then will contact someone who fits their needs better. I think this is just fine. I want clients to find what works best for them.
Many of my past and even current clients would probably be surprised to here me say this: I bring a considerable amount of self-doubt into most sessions. I am always a little nervous every time I leave my office to go out to the lobby to greet my client for that session. I have doubts about whether I will know what that client needs from me on that day, whether I will know what to say, how to feel about myself and them, how to be present for them in a way that is real and open to whatever they might happen to have going on with them. I am often not even sure how to start the session, how to open up the dialogue, whether I should say something or let them speak first. I really mean that I go through this thought process most of the time before and at the beginning of sessions. This is still true after ten years of doing therapy. Here’s the thing, though: I want it to be this way. I wouldn’t want it to be any other way. I trust my doubt. I find it inspiring. It isn’t fake. I don’t “try to be doubtful.” It is not some kind of contrived state, the “not knowing” mindfulness thing. It is real, natural, and actually sometimes pretty uncomfortable. The (usually) slight anxiety I bring into each session keeps me alert, honest with myself, appropriately humble and open to my limitations, my lack of knowledge about that client on that day.
There is a scene in John Steinbeck’s “The Grapes of Wrath” (it’s in either the book or movie, I can’t remember which, or maybe it’s in both) that captures this sentiment of not knowing so well. At the beginning of the book, the main character, Tom Joad, runs into the local town minister. They walk together for a bit, catching up on what’s new since Tom went to prison. Much later in the book, they run into each other again at a labor protest. The minister is there as a protestor, a labor agitator. Tom asks him why he isn’t preaching. The minister says (I’m paraphrasing based on my memory of the scene), “A preacher man, he got to know, know the answers. I ain’t got the answers no more, Tom, alls I gots is questions, so I can’t be a preacher man no more.” Like him, I am no preacher. I do not have “the answers” to anyone’s problems. I have ideas. I have questions. I have care, concern, and curiosity. I have limited but helpful knowledge based on education and experiences about human behavior, motivations, and interactional patterns in relationships. I use these ideas and knowledges as a basis to observe and listen to clients tell me about themselves and their life situations. I offer these observations to clients to see what fits for them. Much of the time, my questions, ideas, and knowledge are right on the button. Other times, they are not. It is always up to the client to decide what fits and what doesn’t. I actively encourage clients to feel free to tell me when my ideas and observations do not fit with their understanding of themselves. Being wrong and being right are both important parts of getting to know the client. When a client tells me I am wrong, it helps us both understand the client in a different way by exploring why it is wrong. I try very hard to not let my own ego (thinking I need to be right to be okay with myself) get in the way of what the client needs to increase their understanding of themselves and create new coping skills for whatever bothers them. After all, as a therapist, I am not in the session for me, I am there for the client.
Copyright 2013, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.