I often struggle to explain the true and real machinations of psychotherapy. Not because I don’t want to but because I have come to understand that at the end of the day it’s a lived experience. Oh yes, I can say it’s this and it’s that. I can explain we will look and delve into this and that. Perhaps I can even explain we cover this and that. Regardless of the approach to an explanation, these formats will never do it justice.
Occasionally I even have this conversation with clients who are down the line in their psychotherapy process. It’s often borne from a comment around; ‘I haven’t worked on X (= a particular issue) but it doesn’t particularly bother me anymore’. Or, worse, ‘I never imagined I’d feel as bad as I did through parts of this process’ or better, ‘I never imagined I could live without those old thoughts feeling and behaviours I had’.
It is a difficult story and experience to explain in doing the process justice.
For sometime now, perhaps two years, I have had an on going issue with my car. I guess at this point it might be worthwhile giving a brief synopsis of my neurotic car ownership.
I have a very old car which I struggle to part with…talk about attachment! Instead of moving on to a modern, upgraded version of four wheels I decided some time ago to keep my old car in top shape and see how long I could keep her. I did this mostly because 1). I struggle to see such a beautiful car crushed up into a ball of steel, just because she is so aged, and thrown into the environment and 2). Oddly, I love her like a family member, we have been together a long time and had many adventures. Remember, I said ‘neurotic’. If you have read my book Delving Deeper, I even start the narrative by talking about her…such is our relationship. I actually begin with, ‘Princess rolls forward of her own volition….!
And perhaps another reason I have kept this car is because many years ago, in her early life, I found a brilliant car surgeon who took wonderful care of her. I guess as with any aged human body, over time, it becomes more and more difficult to keep the ‘bits’ going. I have learned a car is no less a challenge.
As mentioned this ‘issue’ (let’s refer to it as her ‘labouring’) began as a mild symptom, worsening slowly over time.
At this stage my car surgeon and I are left to wonder that if in the initial appointment she was in fact misdiagnosed. This being not so much the fault of the surgeon than the misleading information given to him, on my behalf, and others.
This always reminds me never to collect data and information from anyone except the client in my practice work.
Eventually, and after approximately four hospitalisations, this brilliant car surgeon said, ‘I think this is a completely different issue’. He asked permission, in his ever respectful manner, to have Princess (I did mention, she also has a name; adding further weight to my neurotic assessment of my ownership) for a longer period to runs some tests.
This analysis confirmed his hunch. She was in fact suffering from a much different ailment than she had originally been diagnosed and treated for.
At this juncture I was about to take leave and so left poor Princess in his workshop for her much needed R & R. This was not so much rest and recreation, as repair and recovery.
I arrived back from leave to collect Princess and found a beaming car surgeon. He felt they had found the issue and that finally there was improvement in her symptoms.
With great excitement and relief, I jumped into Princess and speed home. Immediately, with relief, I too noted great improvement.
However, I was sad to report, as one does after a small piece of psychotherapy work, Princess was not fully repaired. She still had, though less, symptoms of her labouring.
In the coming weeks I felt disappointed that the treatment had not been completely successful. And if I was to be honest with myself it was the same as before or even becoming worse after those few short weeks I had had her back for treatment. Reluctantly I called the genius car surgeon to inform him. He was surprisingly up beat and said, ‘oh that’s fine, we were not sure how much to do and only did a few basic things. So if you feel it was initially better at least we are on the right track’.
On reflection he sound somewhat similar to me with a client who reports feeling worse after being in psychotherapy for some time. Like him I often know we were on the right track, but with psychotherapy one does need to feel worse before one can feel better.
The car surgeon explained he would want to see her again for a longer period.
Disappointingly this went on for so long, one day asked if I just needed to put her down…euthanasia her? He and his assistants were mortified. He glared at me, reproachfully, saying, ‘she’s better than ever, we just need to sort this issue.’
In that moment I had a visceral experience, I stood to attention and listened to him. I knew what my clients felt about their work with me. And that sometimes it just did not feel like it was getting better, and in fact, getting worse. And that at some level they felt the work and I had failed them.
As an adjunct to this story my family and friends would have had apoplexy if they knew the cost her surgery had began amassing. This is the same with psychotherapy. It is long term. Very long term. It takes much time. It is a system where by the psychotherapist and client endlessly search of information, understanding, delving, hypothesising, analysing, looking for answers. It’s an emotional roller coaster of ‘I feel better…I feel worse…I feel better…I feel nothing…I feel worse than ever’. And it also costs a lot of money.
It’s rare I enter into a working contract without telling people these crucial components of this work. Oh, and I will always say to the client in the early stages of treatment; ‘when you least want to come to session is when you most need to come (to sessions). Just as my car surgeon was saying to me on this day. He was saying it was not time to get rid of Princess, we had worked hard, she was in great condition, not ideal, but much better.
In keeping with my own principles and work ethic Princess went back into hospitalisation, for that protracted period.
Excitingly this treatment series rendered a successful result.
It was the final comment of the younger car surgeon that prompted this blog.
While speaking incredulously to the senior car surgeon and laughing with relief at the successful result, he said they did many things and as a result were unaware of exactly what created the precise change. I was quite confused. However it was what the younger man said that it dawned on me…there was a real parallel between this experience and my work. He said, ‘oh you know…when you work on a lot of little things you get greater change in other areas’.
Bam! In one short off-the-cuff comment he summed up how psychotherapy works.