Social Anxiety Documentary: Afraid of People
How important is the way I feel with and about my doctor?
Your feelings with and about your doctor are absolutely critical. The person who treats you will be responsible for creating a safe, therapeutic environment and relationship in which and with which to heal. In order for recovery to start, it is important that you feel as comfortable as possible in the frank discussion of painful, at times traumatic, parts of your life history and symptom course.
The gut feeling you have about the person administering your treatment cannot be overstated. You are entrusting your mind and health care to this person and choosing well can, in the long run, save a lot of problems, time, and money. Many aspects of the psychotherapeutic treatment involve the therapist’s personality as much as what he or she may know, so it is important that this fit be good enough for you to get better.
Having a good feeling about your therapist does not mean, necessarily, liking your therapist, especially as the work deepens. In particular, if you work more deeply to understand painful, difficult aspects of your personality, the therapist may eventually and predictably assume roles of significant people from your past, not all of whom were likable (if one of your symptoms is anxiety). This phenomenon is called transference, and it can be of high yield in illuminating patterns that you bring to the table time and again in your expectation of an anxiety-provoking situation. Feeling that your therapist is about to beat you or trigger explosive feelings of rage does not stir warm feelings and affection. In contrast, over liking or idealizing your therapist can be just as useful in learning about situations that you might find disturbing.
To flip the transference example around, you might find yourself thinking your therapist is one of the neatest, most intelligent, likable, warm people you have ever had the good fortune to meet, feelings which in aggregate can help hide deeper fears of being taken advantage of, hated, or abandoned.
No matter whether your therapist takes on a likable or unlikable role, any good therapist conveys a sense of seriousness for the work at hand and respect for your life history as an individual. This sense of safety can be felt and appreciated, even if you hate your therapist in the moment. With a skilled therapist, these feelings of hatred can be understood as important communications in conjunction with what you have been working on recently.
This interface illustrates the value of competence. An experienced therapist can help the patient learn the real value of making sense of the feelings he or she has in any moment. These exchanges transcend the patient’s need to like the therapist, or the therapist’s need or wish to be liked by the patient.
The years that I was in analysis, I was heavily involved in the arts. I was an actress, on stage a lot, and very much a part of the city’s arts community. I attended opera, dance, and music performances. Our city is not large, and my analyst was also a music and opera aficionado, so our paths crossed frequently. One time he told me he was at a high school music evening and saw my daughter on the dance team. I said, “How did you know my daughter?” (The dance team had well over 30 girls, all dressed identically; in my opinion, they all looked alarmingly alike.)He said, “She looks just like you.” I thought about that comment a lot. For a man who didn’t say much, this came as a surprise. He, however, was on my mind night and day. I didn’t think he ever thought of me. Besides, I had great worries that my constant repetitive complaints must bore him. I realized that he did think of me, and I took comfort in his remark. I was surprised to learn how important it was to me that he ever thought of me. I took the sort of comfort one feels when they find they have a friend whom they didn’t know about. One night after a performance of a play I was in, I checked the house tickets and discovered that he had come to the play with his wife and had sat way in the back. In our next session, I thanked him, being so surprised and pleased that he had attended. (He certainly knew the agonies I had endured in its preparation.) I told him that I could have found him tickets up front, but he said only that he preferred to sit in the back. But I derived the same pleasure I had before from the high school performance comment. I was making myself very vulnerable in this analysis, and I had a lot of emotion about all of this. It was a comfort to know that this quiet, impassive-looking person had a response to me and actually did think about me. It came as a revelation, and a nice one.
Another time I received a bad review and was angry and hurt. I was playing a prostitute in a comedy, which the reviewer had found to be too realistic and harsh, he wrote, for a comedy. I complained about this in analysis. First, my analyst said he thought the reviewer was upset by his own feelings to such a realistic portrayal of this character. But really, as it was a comedy, why did I not smile? He had noticed it too, as he had seen the performance. The wealth of material and work we did just on this comment made all the weeks of rehearsal and all of the other work so worthwhile. It was phenomenal.
I had monumental work to do, and it absolutely could never have been done if I had not been able to care about my analyst. It was not a business relationship, and it was not a technical one. He was my well-trained doctor and unusual kind of friend in this enterprise toward which we both gave time, respect, thought, and hard work. We made ourselves open and trusting to one another. He occupies a place in my life that is unique, and without love, affection, and respect, it could never have happened.
What are signs that a therapist might be inappropriate?
The most important sign would be your gut feeling. If you have a sense of the creeps around the professional evaluating you, pay attention. If this feeling cannot be explored with the therapist in a way that leads to productive and useful understanding of your life’s story, then you’re probably with the wrong person. Even in the best of hands, there are times that for reasons unclear to us, the fit simply may be off. You will be better served by taking care of yourself and finding a treatment provider with whom you feel more comfortable.
Other behaviors that would concern me include, but need not be limited to, any therapist who would wish to extend the professional relationship to a personal one; chronically run late; speak at length about his or her personal life or other patients he has treated in more than a brief, situational way for purposes of education; lose her temper with you or speak judgmentally about your actions other than in an attempt to keep the treatment and/or your life safe; prove unable to listen genuinely to your anger with him or her and take that communication seriously; attempt to introduce you to fellow patients in his or her practice; seek advice from you in your own field or specialty; or treat your case history as less than confidential. Any professional who would wish to date you or involve sexual practice as a component of the treatment would be predatory, abusive, and in violation of the law. If this occurs, you are being abused, not treated. Getting the appropriate help means leaving that relationship and considering the impact of what has happened with someone expert in the realm of boundary violations. You might start the process of finding a clinician with experience in these matters by contacting the director or the ethics chairman of your local American Psychiatric Association or American Psychoanalytic Association branch. If you believe that your therapist has been inappropriate with you, you deserve a second opinion. Obtaining this evaluation can serve several functions and often leads to a positive outcome. You might learn that, in fact, your therapist has been inappropriate by taking advantage of you or by working counter therapeutically with you. A second opinion might provide the catalyst you need to arrange for a safer, more therapeutic treatment. A second opinion might also help you to understand any distortions you may have added to your own story of what felt so inappropriate at the time but in retrospect seem more like overreactions. The consultation with a neutral party in these examples honors the tradition of all good psychotherapy-that speaking openly and on the record about your mind’s experience and your actions can yield relief from the very underlying anxiety that can create distortions so powerful that we might believe our therapist wishes to abuse us. In this spirit, the consultation can facilitate a safe return to the prior treatment and psychotherapist.
Twelve-step groups work via a different model-using the full strength of the group-and may be much more social than an individual treatment. Commonly, there is less of a boundary between group leader and group member, as often self-revelation on behalf of the leader allows the group to stand justly on even ground. Such revelation is thus entirely appropriate.
Next: How important is my actual diagnosis in determining the kind of treatment I get for myself?
