Author: Meng Xianghan
Psychologists are a high-risk profession.
This high risk is not limited to being in a closed space, facing a client who may be extremely unstable. In addition, psychological counselors place themselves in a position where they can be influenced by clients, so they will slip into an unethical situation if they are not careful. Role, falling in love with clients or even exploiting clients, it will violate the ethics code of counselors, and such counselors will personally ruin their careers! !
So how to prevent such a thing from happening in advance? ! The American TV series "Inquiry from the Heart" gave us some interesting inspirations.
Our protagonist Paul (Gabriel Byrne), a middle-aged psychiatrist, receives four different but "fixed" clients in the counseling room of his home from the first to the fourth day of every week;
Monday was Laura Hill , 30, a sullen 30-year-old anesthesiologist, sexy and beautiful, self-destructive, and in love with her psychiatrist;
Tuesday was Alex Prince, a bomber pilot with typical narcissistic personality disorder who bombed a school in Baghdad and killed 16 children without feeling guilty;
Wednesday was Sophie, a 16-year-old female gymnast who was smart, acerbic, chaotic, girlish innocence, suicidal, and whose life was basically ruined by the adults around her;
Thursday was Amy and Jake, a troubled couple, arguing over whether to get pregnant or to have an abortion.
On Friday, Paul went to see his youth mentor Gina, a warm, sensitive listener and protector, but the debate between them was at its most intense and sometimes exhausting due to old feuds and new wounds. But I'm not sure whether Gina is Paul's supervisor or a personal experiencer, because the role of supervision is mainly to provide technical and relational guidance to some cases of the therapist during this period. It is an authoritative relationship, but A personal experiencer is different. He is more like a psychologist's psychologist. He is used to solve the psychological problems of the psychologist himself, but it is clear that the two characters in the TV are mixed into one, and they are also given to Paul and his wife. Kate does family therapy, it's clearly a dual relationship, and I don't know what could have caused such a mistake. WeChat ID: psycexpress
Heart-to-Heart Consultation can be said to be an American TV drama that is closest to the real psychotherapy setting. Of course, each episode is 25 minutes, which is not the time setting under real consultation. The usual counseling time for psychological counseling is generally 50 minutes, and some counselors use 45 minutes and 1 hour settings.
The frequency of classical psychoanalytically oriented psychotherapy is four times a week, and the client is lying on a reclining chair, and the psychotherapist will not sit opposite the patient, but will sit behind the patient, the main method used is freedom. Associative, the analyst doesn't have a lot of language, it's more about letting the patient speak for himself whatever comes to his head.
And the analyst Paul on the TV, his psychotherapy setting is obviously weekly, the main initiator of the dialogue is the patient, and each consultation summary does not have a clear theme, but a free associative talk, treatment The relationship mainly deals with the transference and countertransference between the therapist and the patient, so the play is psychodynamically oriented psychotherapy.
In fact, the translation of the Chinese name of "Mengxin Interrogation" is very good, because introspection is self-examination. In real psychotherapy, the therapist does not mean to ask the client all kinds of questions, because the answer to the question is often hidden. The self-awareness of the therapist (including what the client expresses and the emotions and feelings the client brings to the therapist) will be extremely important in terms of the form of expression and the empathy it brings to the therapist. resource.
The treatment of this transference and countertransference can be used to understand the client, build the counseling relationship, and complete the counseling healing process. Psychotherapy is a professional service industry, which is not like other service industries that can bring substantial external changes to customers, such as the physical changes brought to customers by barbers and masseuses, etc. The scope of psychotherapy services Mainly at the psychological and interactive level of the individual or family, this kind of service emphasizes that the counselor's therapeutic position cannot slip out of the role of a psychotherapist. For example, Paul on TV almost slipped from the role of psychotherapy to Laur. lover role.
The ACA Code of Ethics issued by the American Association of Counselors shows:
A.5.c. Sexual and/or romantic counselor clientinteractions or relationships with former clients, their romantic partners, ortheir family members are prohibited for a period of 5 years following the lastprofessional contact. A.5.c The provider must not engage in any form of sexual or intimate relationship with the professional seeking provider or with a family member for at least five years after the provider ends the counseling or therapeutic relationship.
In China, the period stipulated in the ethics of psychologists is 3 years.
In reality, if the therapeutic relationship is broken, for example, the relationship between counseling and visiting has become a friendship, for example, if the counselor is delayed by ten minutes, for example, if the patient or the therapist is late, etc., these behaviors are meaningful and useless. Acting-out caused by language to speak .
Of Paul's four patients, Laura was the only one who kept Paul regularly slipping out of the therapist role and frame of therapy, pursuing Paul with passion and with a passion for accepting predatory behavior. Early in therapy, when Laura admitted during therapy that she loved Paul, he responded, "I'm not an option." But it was clear that Paul had feelings for Laura, which sparked a conflict in Paul's work ethic, which was A central conflict in the show. WeChat ID: psycexpress
During therapy, only when the therapist adheres to the therapeutic framework and internalizes the analytical attitude, it is more difficult for the therapeutic relationship to be broken, and even unethical events occur.
(1) Therapeutic framework
The framework of psychotherapy is the basis for establishing the therapeutic relationship, which includes the time of each treatment, the frequency of treatment, the location of treatment, the cost, the definition of the treatment relationship, and so on!
Psychotherapy in a real-world setting follows a therapeutic framework, as shown on TV, with weekly meetings at a set time for $150 each, at Paul's home. The therapeutic relationship is a professional service relationship. In psychotherapy, the therapist and the patient will have many emotions. For example, the patient likes the client, or complains that the treatment cost is too high, or complains that the therapist is cold-blooded and so on.
The role of the therapist is to deal with these emotions, not to actually reject the patient, reduce the cost of treatment, or become more enthusiastic about the patient. For example, when the patient says, "Why are you so cold-blooded! Every time I ask you a question, you don't answer it directly." The therapist does not say, "I don't have it." This kind of denial is not a "therapist". Instead answer:
"When you said I was cold-blooded, I felt a kind of anger from you. It sounds like you want to get my response. When you don't get such a response, you are very angry. I don't know if this is the case. It's also in your other relationships, can you talk about it?"
Such an answer maintains the therapeutic boundary and turns the patient's attention to self-reflection. At the same time, the therapist should use the third eye to examine the emotions aroused during the treatment process, not to suppress them, but to let them happen naturally, just to observe the emotions neutrally and not be taken away by the emotions. .
(2) Analytical attitude
Then another question is, what is the analytical attitude in therapy:
1. Empathy
Empathy requires the therapist to focus on listening and understanding the patient's inner world. The therapist wants to stay with the patient rather than protect himself. It also means opening up to painful conflicts and experiences, which shows the therapist's willingness to endure what the patient cannot bear. inner world. For example, Laura has a strong love and sexual empathy for Paul, and Paul also has a strong counter-transference to Laura, but Paul avoids this emotion. Paul could have expressed empathy and advancement in many ways. The treatment process, but he missed it, he can say:
"Laura, as much as I love you, I prefer to be your therapist, and I know you may not believe that if we had sex, I wouldn't be able to be your therapist. You can find many people who would like to have sex with you. relationship man, so why insist on happening in this relationship. Having this unique therapeutic relationship is more valuable to both you and me. Here we can do it without destroying our most valuable therapeutic relationship , explore what we mean in every aspect of fantasy and understand what it means to you."
2. Coordination and response
The English word for coordination is Attunement, which has many different meanings. The main meaning is that it is like listening to the radio. We want to tune to a certain channel. Likewise, in psychotherapy, the therapist needs to tune himself into the same channel as the client, able to listen to the patient. The English word for reaction is Reflection, which means that a person looks at the lake and sees his own shadow. Therefore, the reaction here is not the therapist's verbal feedback to the patient, but the observation of his own emotional and physical reactions. WeChat ID: psycexpress
3. Pay attention to uniform suspension
This means that the therapist allows himself to be touched by the patient during the treatment process, allowing the emotional development, and at the same time having the ability to reflect on the relationship between the two at this time. It is an open, influenceable, non-solid, dynamic attention. The therapist does not select what to pay attention to from the patient's speech, but spreads all the material evenly in his own feelings, listens in an empathetic way, and at the same time has the ability to hear what he hears and what he hears. Feel and think. As Bion admonishes therapists to achieve a state of "no memory and no desire".
4. Reliability
The entire psychotherapy is based on a basic sense of security and trust. It can be said that any professional service is based on these two basic feelings . Trust is part of the work alliance and is a condition of therapeutic work, and the therapist should understand the patient’s elements of restlessness and mistrust, and often discuss the relationship with the patient, such as
"Do you feel comfortable talking to me?" "How do you think the treatment process is going?" "What do you think I do that will allow you to express more freely here"
The therapist must help the patient understand the nature of the relationship, show that he has enough self-control to make the patient feel safe, and know that the therapist will not act on [any sexual feelings].
For example, throughout the treatment process, although Paul had strong feelings for Laura and often avoided his feelings for Laura, during the treatment, Paul did not really do any intimate behavior to Laura, which was enough to make Laura trust Paul as a therapist professional quality.
5. Neutrality
The attitude of neutrality is that we do not make decisions for the client, nor is it an attitude of emotional alienation or indifference, it is not a whiteboard for the therapist to act. Neutrality is the position of an observer who sees what is going on. The therapist is not friendly, warm or curious, but not impersonal . This attitude gives room for any possible emotional expression! The facilitator allows patients to express their inner feelings freely without worrying about being criticized and accused. WeChat ID: psycexpress
6. Seek truth from facts
This attitude tells the therapist not to be insincere, and he gives both partners a space to speak up that doesn't shy away from painful realities.
7. As a container for unbearable feelings
The therapist allows any feelings of the patient to exist. The therapist should let the patient feel that in the treatment environment, he can do so without covering up or running away, and let the patient believe that there will be a bright future, but before seeing the light, he needs to stay in the dark temporarily. This is the tension and pressure we therapists need to endure.
But Paul on TV is not good enough in some ways, like in the first episode when Laura is crying, Paul pushes the carton towards her. It seems like a harmless gesture, or even a gesture of sympathy, which ordinary people do on a regular basis.
But within an analytical framework, any gesture by the patient or therapist is worth reflecting on. The profound meaning of Paul's behavior here is "I can't stand your tears, I can't stand the pain you show in front of me" . This action represented the therapist's denial of Laura's complete openness. In subsequent performances, this kind of refusal also often appeared. For example, Paul felt Laura was cold, so he brought her a blanket; asked Laura if she needed to help her get a taxi... It's not wrong in this way, Rather, in an analytical framework, it's all rich in meaning, and we should discuss the implications of this behavior rather than act directly. There is also this behavior is to tell the patient "you are not equipped to deal with these challenges." Paul has no way to allow a vulnerable Laura to show up in front of him, nor can he tolerate an incompetent self in front of Laura.
If the above seven points are achieved, combined with the therapeutic framework, the treatment room becomes a therapeutic space, and the therapist's job is to internalize the analytical attitude and maintain the therapeutic framework.
Of course, Paul is also a real person on TV, and this kind of real response to emotion is appropriate, but it is not to take action against this emotion, such as going to Laura in the end, which has violated the ethics of treatment, it is already Breaking the therapeutic framework and entering into the level of action, this aspect should be discussed with her supervisor and experiencer in time, because Laura finally knows that she has a sense of accomplishment by seducing other men, and she will use this method in the same way. Applied to Paul, Laura understood her own pattern and terminated the treatment, and finally Gina reluctantly said " this treatment was an unexpected success".
In short, no matter how experienced a therapist is, he is also a person in essence, and he also has his own love-hate emotions, and the process of psychotherapy cannot block the expression of such love-hate emotions. A client falling in love with a therapist does not mean A crisis, but a turning point, requires us to internalize that analytical attitude, protect the therapeutic framework, and openly talk to the client within it, without being carried away by emotions. Such treatment is a better psychodynamic oriented treatment.
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