Blind Spots In Psychotherapy

 

A good therapist fails. How do we understand this? What, anyway, is a “good therapist”? Is there a “good therapist” or a “good therapist-patient fit”? These are the questions which have no answers, but generate more questions. Often, when I am asked for a referral, I think about “fit” but I recognize that this is largely an intuitive process which involves educated guessing. The dyad brings up issues for both the patient and the therapist, and if the injuries in the patient hit close to injuries in the therapist, this can cause a “blind spot” as James McLaughlin has described. Monte and Marla come to mind. https://shirahvollmermd.wordpress.com/2011/08/10/monte-and-marla-on-the-rise-again/. Monte and Marla, both psychiatrists have been working together for many decades. By working together I mean that Monte has sought guidance from Marla for his career, but the relationship has bled into personal matters as well. Monte grew up in a family where he felt he had to please his parents. So did Marla. When Monte spoke about his narcissistic parents, Marla defended his parents by saying “they did the best they could,” thereby making Monte feel dismissed. Monte came to see me, and in our work together we postulated that perhaps Marla could not help Monte cope with being unseen by his parents because Marla has never resolved this very same issue with her parents. The collision of these two traumatic experiences created a blind spot in Marla which caused Monte considerable distress. Unresolved traumas create a defensiveness when a similar situation is described, either in film, in literature or in person. So too, with psychotherapy, unresolved issues in the therapist, can lead to a coldness when these same issues are presented by the patient. This coldness is a way for the therapist to avoid the deep pain associated with her past. It is a wish to think that therapists have resolved all of their issues such these blind spots never happen. They do happen, making the  hope in the ability of the therapist to come to recognize the deficit and try to move the therapy forward. Like my last cartoon post, like life, we want the path of psychotherapy to be linear, but in fact, it goes up and down.