We’ve been discussing ways to reach clients who lack a language with which to share their internal world with us as well as those who seem to be cut off from their inner world.

In order to move forward, a brief few words on proxies and doubles will help.

All of us are familiar with serious sports fans. These are crazy people. Perhaps, some of us are such people. For a real fan, the connection to their team or favorite player whisks them away to a magical place; they become so consumed by their target that they forget themselves. True fandom goes beyond simple identification; it’s to let that player or team do and be all the things that the fan cannot do or be.

Of course, the use of proxies is not limited to sports; we find artistic proxies, style proxies, political proxies, moral proxies, spiritual proxies, scholarship proxies, power proxies and many many other kinds. These are all people or objects, some real, some not, who via identification (and then some!) do things for us that we cannot do.

For many people proxies however become tools for expression and offer a kind of inner life. This is one of the roles of celebrities in modern life: celebrities (and each culture has such people) have far more appealing lives and ways to express themselves than many of our clients think of their own lives and ideas. They are caught up in the deep shame pervading our culture, a shame born of not feeling that they have a worthy voice or life, to be shared with others. So they let others do the talking for them. 

In practice, then I will gather information on who the proxies are: characters in television shows, newsmakers, rabonim and tzadikim, singers, and celebrities. What do these proxies say and do on behalf of the client? What we do with this data is for coming installments.

אתמול דברנו על הטירונים, שמוזרות טיפול פסיכותרפיוטי גרידא משתיקה אותם. היום, נדבר באלו שחסרים להם שפה לעולם הפנימי משותפת שדרכה הם יכולים לשתף אותנו (ואחרים!) בעולמם פנימי.

בכלל, אנו, לדעתי, מדגשים תקשורת מילולית מדי. אולי זה בגלל החוסר סבלנות התרבותי: כולנו רוצים אינפורמציה מיד וללית אפשרות להתקין שקע USD בכדי להוריד את האינפורמציה במהירות 10 מגה לשנייה דרך כבל, אנו ׳מתמודדים׳ עם תקשורת מילולית. אבל מה שאנו שוכחים שאפילו פרויד (זוכרים אותו?) יותר השתמש בסימפטומים חיצונים (כהיסטריה ועוד סוגי מחלות פיזיות) כגשר לעולם פנימי.

בעצם מה שנאמר פה שאינפרציה1 ללא דרישה לתקשורת מילולי היא הדרך לפתוח לגשר להרבה קליינטים. אנו פשוט שמים לב: איך הם לבושים, איך נראים, ואיך מרגישים פיזי (אני מסתייע ברשימה של מחלות קלות כאבים שונים שאני מראה לקליינטים שקשה להם לדבר). הגוף ונפש מחוברים ולהקשיב לגוף היא גם להקשיב לנפש.

ויש עוד דרך: לפעמים כתיבה היא הרבה יותר נוחה. אני מזמין קליינטים לכתוב: אימיילים, יומנים, שירים, בלוגים, ותגובות בבלוגים של אחרים. בדרכי הבעה אלה קליינטים יכולים לשלוף מעולמם פנימי במנגנון ובצורה מוכר להם ולשתף אותנו במה שקורה. זכור לי לא מעט מקרים שקליינטים באמצע שיחה ׳רגילה׳ פתחו מחשבים ניידים וטלפונים ושלחו אלי (שיושב במרחק מטר) מיילים וסמסים ונהנלנו חלקים חשובים בפורמט זו. כמובן, אנו חייבים גם להתחשב בעצמנו: איך נשתמש בחומר ובגישה זה ואיך לנהל את הצד האתי וגם הצד העסקי.

וגם יש דרכי אחרים וכמובן הרבה הרבה שיקולים. נגיע להם מחר.

Yesterday, we spoke of rookies and their difficulties sharing their inner world with us. Today, we’ll begin considering those who seem to lack any verbal way of accessing their inner world and sharing it with us (and with others!).

In general, and this is my opinion, we emphasize verbal communication too much. The result is a negative feedback look in which many, especially these non-verbal folks, feel out-gunned by us talkative, gabby folks. What we forget is that even Freud (remember him?) used indirect observation of ‘symptoms’ (hysterical reactions for instance) as a bridge to his patients inner world. 

Essentially, what’s being said here is that inference without expectation of verbal communication is the way to bridge the gap with many clients. We simply pay attention: to their dress, how they appear, how they are feeling physically. I make use of a list of common somatic complaints and illness which the client can choose from. The mind and body are connected and by querying the body, I can learn about the mind connected to it. 

And there is another way: writing is very often much more comfortable for clients. I invite my clients to write whether it be in the form of letters, emails, diaries, poetry, blogs, and comments in the blogs of others. Via these methods of expression, clients are able to express themselves in a way that is comfortable and safe for them. In fact from time to time, clients will open their laptops or phones and send a message or text to me, sitting a meter away from them. Of course, we must also consider our own needs including the the ethical and business dimensions of these methods.

Tomorrow we’ll get to some more ways.

Continuing the discussion of engaging those who have difficulties speaking of their inner worlds, the most easiest to help are those who are therapy novices. Like someone who has never entered a bowling alley before, they’re clueless about what to expect. Such confusion is enough to shut anyone down. What makes matters worse is the taboo nature of the therapy encounter. Our work is stigmatized or derided by the public. We meet with people behind closed doors often in spaces that are utterly foreign to most people.

There is much to be done to help these novices. We can take the time to explain the process: how sessions are structured, what to expect to happen by the end of the session, what to expect of the therapist and what the therapist expects of the client. We can offer illustrative examples either through directing the client to accounts of treatment or through sprinkling our sessions with bits and pieces of our or others’ experiences.

In the sessions themselves we can use forms, handouts, posters, diagrams, and metaphors that connect with the client’s frame of reference. We can seek feedback from the client during and after the session and then incorporate that feedback into the work. As a cognitive therapist, I regularly ask my clients one or more of these questions:

Is this idea, interpretation, idea etc. helpful?

Am I helping you?

Do you think that I understand what you’ve explained to me?

Is there anything that we’ve left out?

Often at the beginning of a session, I’ll say, “at such and such time, you will be leaving my office. What do you want to have spoken about or examined?”

Clients, out of pain or misunderstanding, are usually impatient; they have exaggerated expectations about how long they need to suffer, what needs to happen before they get what they want, or whatever. I share that impatience with them; I too don’t want them to suffer. What I also share with them is that they are not stupid or lazy; the difficulties that they seek help for are not trivial. Otherwise they would have solved them long ago. Therefore we both must approach the issues with respect. 

Can we make therapy as pleasant as going bowling? Sometimes. But we can definitely do much to keep it out of the gutter. 

Shavua Tov to all!