The writer tells us about the topic of therapist’ dilemmas emerged when he turned with a particular dilemma he was experiencing with a client at that time. Thus all his research was in vain since it led to question the limits of the scientific practitioner model currently in vogue in the field of clinical practice. He says his aim was to re-create that kind of informal atmosphere where contributors would feel relaxed enough to discuss their dilemmas in public. To achieve this he decided an interview format since that medium was most closely approximates the interactive setting in which therapist discuss their dilemmas. The interviews focus on the frame of reference of the contributor than to shift it to that of the interviewer.
A final draft was made considering on what dilemmas do therapists have:
Who Am I To Teach Morals?
Who am I to teach morals is a conversation between windy Dryden and peter lomas.Peter lomas is a was trained in medicine at Manchester and became a senior house surgeon to sir Geoffrey Jefferson at the Manchester royal infirmary, and was a general practitioner for six years then he trained at the institute of psychoanalysis in London he has worked in mental hospital a child guidance clinic a school for maladjusted adolescent boys. At present he is involved in teaching set up in which students are encourage to use their own initiative in finding the optimal means by which they can learn psychotherapy. Peters aim is to understand the factors which stand in the way of an open and equal relationship between the therapist and client.
In this conversation about who am I to teach morals windy Dryden ask questions about the dilemma peter lomas is facing as therapist. Here peter lomas is confused that from where the morality comes from in the field of psychotherapy, and how far does ones own set of values influence his client peter says that people him are usually those whose lives have gone badly away from the right track and they came for the solution to find their way in their life, here the dilemma begins that should he teach his clients moral values and make them a kind of person he admire or the kind of person who is good according to the standard that he or perhaps many other person would admire or is acceptable in a society or a person who might regard as virtuous according to philosophers and religious scholars on the other hand he thinks he is not a preacher or does he has a right to impose his moral system on his clients as said he would he would not like if someone else comes to him and teach him own set of morals furthermore a persons who try to turn him out the way he want him to be. As an example he discusses a case of a client who come to him having an issues with the authorities of the hospital his client questioned the doctor about his treatment he had but now is worried about making nuisance of himself he is confused whether he had a right to challenge the authority or he should go along with what was being done. Now here in this situation the dilemma faced by the therapist is that according to him he favor challenge and rebellion but does not want his valves to influence the decision of his client furthermore he thinks that he should be open with his client in his client what is happening between him and his client. Windy Dryden then gave him a suggestion and open a new way of solving problem he said that as therapist he should discuss both point of his views with his client for example his own values and other possible choices. In the situation discussed earlier peter lomas should have tell his client that if he would be at his placed he would have challenge the authorities of the hospital however there are other ways too and you have to select which option suites you the most.
Peter lomas discusses another example of a woman who was confused that should she get her baby aborted or not now her dilemma faces by the therapist is that according to his moral abortion is not a right way but looking at all the situation a girl was facing abortion was a best choice.
At the end of the conversation peter it is concluded that peters dilemma is neither he wants to impose his values on clients nor does he wants to remain neutral. He actually wants his clients to know where they are stand on things and for doing that he thinks that he would have to be tactful and must use his common sense in therapy just as much as in ordinary life.
“Who Am I to Teach Morals?”
An interview with Peter Lomas
Peter Lomas, following, medical education, trained as a psychoanalyst with the British Psycho-Analytical Society, but has since become deeply critical of what he sees as a largely impersonal and withholding set of techniques, at least as practiced in traditional psychoanalytic therapy. Peter Lomas was particularly interested in the nature of the psychotherapeutic relationship and has a long list of publications to his credit, such as True and False Experience, Beyond Interpretation and more recently Cultivating Intuition, most of which concentrate upon analyzing the therapeutic relationship. He challenges some of the laid down notions of what is assumed to be good practice.
Peter’s aim was to understand the factors which stand in the way of an open and equal relationship between therapist and client and most of his writings focus on this question. He believed that professionals take for granted an unjustifiable superiority in conceiving what takes place between the two participants and explores some of these issues in an interview with Windy Dryden.
The ‘dilemma’ he talks about with Dryden is concerning the question of where morality comes into psychotherapy. Particularly of the issue of how far one’s own set of values actually influence what one is doing as a therapist. He says that as a therapist he has some idea in his mind of the kind of people he wants his clients to turn out to be. Lomas think that consciously or unconsciously he aims for his client to become the kind of person he admires, likes, the kind of person he himself might want to be with. That means the client could (if the therapist influences him) end up having values that are similar to the therapist. Lomas says that he would like his client to end up as a ‘good person’ in a moral sense and good according to standards that he or perhaps other people may find acceptable.
Lomas says that it could said that he is in the business of “character building” he considers himself as a ‘priest’ (not religiously) in the broadest sense. However he says that he does not want to impose his values or moral systems of belief on somebody else. He himself he says might not like it and would not want to put himself in a ‘vulnerable position’ where he might be influenced to adopt a set of beliefs. This is where he finds the dilemma to be. He says that he will try to influence his client in some way or the other; he cannot just simply not say anything and leave his clients as they are. For example he says that in a straightforward situation like a person who steals, he would not feel particularly uneasy about trying to influence him, by self-understanding or by helping him feel more secure so he doesn’t feel the need to steal. In this situation he says he wouldn’t have a dilemma and would know what to tell the person because most people would say it is a good change and it would be beneficial for his client. He says
issues concerning conformity and rebellion are the kinds that are tricky. In situations like if a person should question or challenge existing authorities are the ones that put a therapist in dilemma. He feels that he has values that favor challenge and rebellion do influence the way he discusses a topic with his client, even if ‘subtly’ Lomas says that if not by speaking openly about his views the client could discern them by his responses, perhaps his non-verbal responses, tone of his voice, bits of approval and so on. He says that his values will become evident. If he thought a clients behavior was inappropriate according to his own values he might question his client differently, if he thought the behavior was appropriate he might not question or make any interpretation.
One thing Lomas thinks very passionately about psychotherapy is that whatever the therapist does he must try not to confuse the client. There should be no double bind communication or cues. The therapist should not pretend that he has no views and is completely neutral to the situation, when he really is not. The client will pick up cues which indicate that the therapist is incongruent and will become more confused. Peter Lomas says that he needs to find a way in which he is not shouting his views at patients or ‘trying to indoctrinate them’ but in a way which he is not hiding his own views to such an extent that he becomes confusing to his clients. “One has to find a middle way in which one doesn’t try to brainwash people into accepting ones views, but also one would not try, as parents tend do to conceal things”
According to Lomas the therapist and the client need to have an open dialogue, in which there is equality as far as possible. If the therapist is open he can discuss the situation with the client and they can discuss the conclusion they reach. The client might believe something, why the therapist on the other hand might disagree with it, but they should discuss it openly. Lomas says that he does not believe that one can be neutral and if one takes a neutral stand it could at times be immoral to sit back and let someone do something very destructive. For example if the therapist thinks that the client might commit suicide, the therapist would want to do something about it and even take drastic measures.
Lomas says that as a therapist he does not want to impose values on his clients nor does he want to remain neutral. He wants his patients to know where he stands. But in certain instances for example if something was going to be particularly painful or traumatically painful to another person he says that he would hold back his own view. If someone had committed a heinous crime he would play it down so that he doesn’t increase the guilt that that person is already feeling. However he says that he feels uneasy doing that and does it to the very minimum.
Peter Lomas says that he “must use common sense in therapy just as much as in ordinary living”
In my opinion psychotherapy endeavors to make lost, and unhappy people able to lead more meaningful more satisfying and more useful lives. This in itself is a highly ethical undertaking. A therapist should be competent and skillful. The therapist should stay as neutral as possible, even though it is hard to do so. The therapist should not impose his values and belief system on his client but should be able to ‘advise’ a better alternative to the situation the client has bought with him. The therapist should not question the client’s beliefs or morals, as everyone has their own set of beliefs or morals which the therapist should respect.
But I feel in instances where intervention becomes necessary, for example if there is a threat that the client might commit suicide or commit murder or something that potentially harms the client or others around him, the therapist should take instant action, even if drastic. In that case the therapist can let his morals and beliefs seep in. Though the therapist is no one to decide between good and wrong but if something of this sort comes up the therapist should intervene. If the therapist feels strongly about something, or some act that the client has committed, talking about it could be painful for the client or could increase feelings of guilt and shame. This should be avoided at the time but not ignored.
Hence I agree with Peter Lomas when he says that the therapist must use his common sense in therapy.
Splitting And Integration In Marital Therapy
Splitting and integration in marital therapy is a conversation between Windy Dryden and Paul Brown.
Paul brown is a clinical and as occupational psychologist. He was the founding chairman of the association of sexual and marital therapist proposed the information of the counseling section of the British psychological society and has just completed a period as chairman of the association of clinical psychologists in private practice. He is coeditor of the new journal entitled sexual and marital therapy and is the review editor for the British journal of guidance and counseling. His own publication includes co authorizing treat yourself to sex. Clinically he works especially in sex and marital therapy. In Splitting and integration in marital therapy Paul Brown as a therapist facing a dilemma that whether he should tell his clients that their marriage cannot go further and it seems so obvious to him that it is going to end. When the client in the first session directly ask for the solution about their marriage as to whether or not their marriage is at the end. Here the therapist is confused, because according to him it seems so obvious that there is no future of the marriage but on the other hand it is difficult for him and at times it is unkind or anti therapeutic by him to not reveal his view about the situation if that view is well founded. Here Paul Brown shares an example of a cancer patient who ask his doctor about the his illness but his doctor dodges him by doing this act the doctor is depriving the individual with an opportunity to cope constructively with the illness Paul Brown compares this situation with the dilemma his facing he find it wrong to dodge his client by not clearly telling him/her a proper solution.
Furthermore he discusses the case of a 46 years old women who was worried about her married life she was having problems with her husband who was not giving her enough time she thinks that he is having an extra marital affair. She ask the therapist directly that “Do you think our marriage is at an end?”therapist Paul Brown before giving her any suggestions invited her husband for a session after discussing issues related to their marriage he concluded that their marriage seems to be blocked the only point her wife is facing is husband not giving her time she felt isolated and cut off and most of her friends suggested her that its time for her to get out of this marriage. As a solution Paul brown suggested her that their marriage is very viable and they should try to carry on with their marriage he thinks that if he would suggest someone that their seem no future of their marriage it would not only effect two people but the whole family setup would be destroyed.
Sex Therapy: Education or Healing?
An Interview with John Bancroft
John Bancroft trained in psychiatry at the Maudsley Hospital and was a clinical reader at Oxford University from 1969- 1976. Later he became a clinical consultant at the Medical Research Council Reproductive Biology Unit in Edinburgh. He has extensive experience in all kinds of clinical sexual problems and done research on various aspects of human sexuality.
John Bancroft’s Professional Dilemma
In his therapy sessions he faces the dilemma of adopting the role of an “educator” or a “healer”.
He defines the healer role as a professionally widely accepted authoritative personality that presents fixed solutions to the couple at a “round table discussion” after taking a thoroughly comprehensive history of the couple in therapy. He believes that there is an “ethical issue” involved in this that a lot of irrelevant but extremely private information is disclosed in such an approach.
He defines the educator role as “directive”. An educator through various behavioural approaches sets the couple behavioural assignments so the relevant problems become identified and possible solutions presented. He believes that the preeminence of the educator role lies in the fact that it presents possible solutions to the couple instead of a fixed authoritative decision and also equips them to deal with possible future related problems.
The dilemma between the two roles arises when he feels that at times some couples may need the healer role of authority more than the educator role. However, at the same time he believes in convincing couples that they are enabled human beings and do not need figures of authority to dictate the ultimate and sole solution to their predicament without their active and continued contribution.
He further claims that it is very easy to bring about improvement in sexual problems. The problem is whether this improvement is maintained. Hence, the supremacy of the educator over the healer is that the educator enables couples to deals with future sex problems without dependency on an outside authoritative figure.
His hypothesis is that the healer is quicker to achieve change because in times of crisis, people need someone with a “sense of power”. However, in understanding and learning to cope with their sexual problems lies the durable solution which he provides to his patients in the educator role.
His background in that of a scientist and he believes the educator role is good science as it avoids making assumptions and value judgments.
Most of the time he believes with conviction that the role of the educator needs to be emphasized, but occasionally he doubts it. He has no evidence to prove when the healer’s authoritative proves more effective. Eventually, he hopes to be able to predict how he should behave with particular couples. Future experience and research will he believes bring improvement in his work.
Death by starvation: whose decision
An interview with Fay Fransella
Fay Fransella is the director of centre for personal construct psychology and emeritus reader in clinical psychology at the University of London. Since the late 1960s she has played an active role a teacher, researcher, author and psychotherapist in making the work of George Kelly known internationally. Her major research work has been concerned with the development of a personal construct theoretical model to account for stuttering. Her other major area of research has been in the field of weight disorder, both obesity and anorexia nervosa.
In this chapter she discusses her dilemma with Windy Dryden. She explained her dilemma “that as a therapist should she intervene with the client who according to her is in danger and is not seeking any help. Such as, young individuals who are suffering with anorexia nervosa as she knows that at the end of the road they are confronted with death. However, she wanted o help these individuals in improving their lifestyle. According to her these individuals are the unhappy individuals she ever comes across with she thinks their problem will worsen if no one would show them the right path. Moreover these individuals these individuals are emotionally disturbed and are not in a position to make right decision for themselves. She thinks that they don’t even assume that they are having any problem and they need help.
According to her there are two reasons for giving these individuals help. (1) Here is a social pressure. And secondly there is a potential threat that they will starve themselves to death. There social circle is effected badly. They are usually stick with there own circle of life and cannot see the world outside their constricted world. She thinks by helping these individuals would be an opportunity for them to see the world outside of there interest. She then talked about personal construct theory and Kelly’s Philosophy which states that the individuals themselves have created this issue for them. There is no prescription for a good way to construct or a bad way to construct their selves. If a something that a person choose for him selves serves a purpose of their life. So, as therapist he has no rights to disregard them or tell them that you should be different than other. Because they have not committed a crime or harmed someone these individuals have not done any thing against the societies norms. Windy Dryden then poses her a question what if the client is over the age of consent does that help you in solving the dilemma or when they are not over the age. She replied, the dilemma still would be there no matter what the age of a client is. She further explained that the problem is not like a school phobia, where parents can force their children to go to school. Because, there is no law states that you have to eat, no law has been made over this issue. But she still wanted to help these individuals and want them to lead a normal life. She says that if she or other therapist would not help them to get rid of the situation than there whole life would spend in a hospital. She further states because she could not rule out her dilemma she referred these individuals to other psychologist. When asked by windy Dryden what if you have no other choice or there is no other psychologist present to whom you can refer your client and you are requested to see an under legal aged girl who is seriously anorexic what would you do? She answered for sure she will see that client but she is not sure whether she would be hostile or unfriendly with the client as she knows that it is very difficult to persuade these individuals. At the end of the conversation she concluded, that her dilemma is still there but now she is aware that how she has to solve it, she added at the end that one can never fully live on a theory or a philosophical principle. One has to find ways other than just believing on theories.
Where are the boundaries?
Brian Thorne is the director of counseling at the University of East Anglia. Brian Thorne has been much concerned to draw on different areas of knowledge and experience in order to enrich his therapeutic practice. He believes that groups, communities and institutions have within then powerful resources for helping the development of individuals which often go untapped and un-channeled. As a committed Christian he has been particularly concerned to relate theological insights and institutional church life to the practice of therapy. His book “Intimacy” is a powerful example of his attempt to move across traditional boundaries in the search of a more holistic approach both to therapy and to human living.
In his interview while talking about his book “Intimacy” Brian Thorne discusses how a traditional therapeutic one hour of a session is a dilemmatic concern. He argues that an hour a day can not help the individual and he himself feels that by spending an hour he is not able to offer much help to the client.
He talks about how if one traditional therapeutic hour is not enough for the client then he is finds ways of helping which are not normally perceived as therapy in any professional sense. The way of helping the client in Thorne’s style results from his intervention and cooperation. Thorne experiences which in many ways seem more closely related to an identified with the client’s day-to-day existence. He feels that when clients want to offer things to their therapists that this behavior may actually be something which is enormously important to clients in terms on the development of their own self concept. Clients can then start seeing themselves as persons who can offer and give. Thorne’s experiences have shown that meeting the client in this kind of context has enriched his relationship with the client; it may have also enriched the confidence of the client.
Thorne also believes in a therapeutic community he thinks that a client who has been exposed to destructive forces it is important to offer appropriate therapeutic climate. Thorne realizes that this climate can not be attained by a one hour session so it becomes necessary to introduce the client to a therapeutic network
The situational problem that Thorne can not seem to overcome in his interview is the relationship with the client. The kind of practice Thorne idealizes has a very thin line between professionalism and incompetence. This kind of therapy entails the client and the therapist to be very closely knitted in a relationship so close that they may overcome the relation of a client and a therapist and begin a journey of friendship that may initiate ethical issues.
I'm not an expert as I am still doing my bachelors in Psychology. However, it was one of the first things I've learn, that a counselor shouldn't befriend the client, especially not while they are still in therapy.
However, just using common sense I can't imagine such relationship being equal. As a counselor, you get to know so much about your client, his darkest thoughts and fears. The stuff nobody would usually tell their friends. I doubt it the client would ever learn the same about the counselor and that itself puts him in a vulnerable position.
Also, the client knows nothing about the counselor, so what are the reasons for wanting to befriend him? The fact he listens? The fact he cares? What about the danger of transference? Also, as a friend, can a counselor still be unbiased in giving advice? What if in real life the counselor doesn't really fulfill the client’s expectations? What if he lets him down like we sometimes let people down simply because we are humans? It could easily cause the client to lose all the trust in the counselor and all the good work would be undone.
It's all too risky I would say. Better not to mix work and pleasure
Confrontation or Collusion?
The Dilemma of a Lonely, Burdened Behavioral Therapist
An Interview with Dougal Mackay
Dougal Mackay is a district top grade psychologist to Bristol and Weston health authority and is based at Barrow Hospital, Bristol. And despite his various administrative responsibilities, he continues to be actively involved in psychotherapy along with cognitive behavioral lines. He has published a number of scientific papers and review chapters on such diverse topic as sexual dysfunction, depression, insomnia, assertion problems, childhood behavior disorder, and anxiety states. He is heavily involved in the training of students from the Plymouth MSc. course in clinical psychology and indeed regards psychotherapy supervision of trainee from all the caring professions as one of his main interest.
Dougal discusses his dilemma with Windy Dryden that as a behavioral therapist it is a difficult decision for him to made whether or not to work directly on the problem the client present with. He believed that he should respect the need of the client and do his best to help them achieve their goals, but sometimes it happen that the area he would want to work is quiet different than what the client had in their mind. He thinks that if follows client will then there would be less chances of the success of his therapy results. Or whether to give his client different perspective on what is really going on in their life. He explains his dilemma by giving an example of a woman who came for help. Her problem was that she could not get out of the house to go to shop. They reason she explain was clear that is unable to assert herself with her husband and cant handle the feeling of resentment towards him. So she herself withdraws into herself and becomes less confident in all kind of social situations. Even passing a stranger in the street becomes a problem for her she consult her doctor who told her that she has agoraphobia and prescribed her tranquillizers. So when medicines dose not work for her. Her doctor referred her to him. Now he is confused should he take her out for walk as requested by the client and her GP. Or on the other hand he could help her t see that she is allowing her husband to trample on her and that it would be better to sought out few things before he start working on her phobia. He also think that by discussing the problem with her husband would be like an opening a can of worms. She suddenly might have realized that her marriage is a total disaster and may be by discussing she would want to leave her husband, but she cant take that step may be because of children, or financial issue. He said he could have solved this problem by discussing all the problems with he husband or he could made her realize all the difficult areas of her life. But he thinks by doing so may be she could end up more depressing than she was before. After hearing the dilemma Windy Dryden asked him that would he like to involve the husband in the therapy. Dougal Mackay answered, that he often does but only when it is really necessary. He said his approach is to understand the problem fully and then try to find the shortest route for achieving the goal. He further added that he does not want to create any unnecessary complications so he prefer to deal with an individual client rather than two or more member from the clients family. He said he prefer to involve husband in therapy where e thinks that this is the only way to produce a change. He than again gave an example, of an 40 years old lady who has been admitted because of depressive episodes, she has been in and out of the psychiatric hospital during the last ten years, she has five adolescent children who have been quiet disturbed because of the condition of their mother. Her husband takes no responsibility for her condition neither he takes any responsibility for any of the house chores or even for finance. The family is heavily in debt. All her husband do is to watch TV and eat food. Now in that case he said he wanted to consult her husband. When he talked to her husband he said no is responsible of her illness she herself has made her life miserable. Now by assessing the attitude of the husband he thinks he has made a mistake, now her husband would take out his anger on the client. So because of that he doesn’t feel comfortable involving other member of the family I therapy. He explained, if he worked with just one client, this gives him freedom to explore any number of options. As soon as he involve spouse in the therapy two things might interfere with the therapy. Firstly, he could only deal with issues which directly relate to the system. He says, than he cannot pursue an individual cognitive processing error at great length without excluding the others. Secondly, by involving significant others as clients, he would have equal responsibility to all parties.
At the end of the discussion he concluded that attitudes and beliefs, both personal and theoretical affect how a therapist feeds backs information to the client.
Dilemma’s in Giving Warmth and love to Clients
Albert Ellis is a highly qualified renowned psychotherapist and author. One of his interest is in his relationship between therapist and their clients. In this connection he has been interviewed by Windy Dryden.
Ellis tells Dryden that the therapist dilemma is how warmly to relate to client’s in general and how warm to be with very vulnerable clients in particular. Ellis had realized that orthodox psychoanalytic style did not give good results so he switched over to active psychoanalysis. This involved praising the client’s for their god traits which would help them get over their problems and he thought that the client had not been treated lovingly in their childhood. He provided verbal affection to the client, his appraisals he downplayed his negative feelings towards the client and emphasized their positive side which they liked. The clients loved that and they patronized him. However it did not bring any noticeable change in their external life, despite the fact that they claimed to be benefitting from the therapy (they were feeling better but not getting better).
The dilemma at that time was between therapeutic and practical considerations. Ellis had a choice between cutting down warmth method and thereby losing their patronage or be practical went onto establish RET ( rational emotive therapy ) along with warmth from time to time problem was how warm to be with exceptionally vulnerable clients. Dryden raised a query regarding short term and long term consequences of therapy. According to Ellis short term warmth was reinforcing, rewarding and kept people in therapy. However later on they have taught i.e. RET to think for themselves, dispute their irrational beliefs, take tasks etc. If the therapist is nice to the clients they work at therapy mainly for the therapist which is a wrong reason. The therapist must show unconditional acceptance to the clients. This kind of acceptance when it works does not make client’s dependant and less needy. For dealing with vulnerable clients including suicidal. In the beginning therapist has to be extra kind to them. They get a glimpse of RET, encouraged to do active disputing, their traits are highlighted and are given hope.
Regarding vulnerable and suicidal clients Ellis says. He combined warm approach with the RET and touched the negative things, they were telling themselves. In a warm fashion he negated leafs like “ I am no good, I am hopeless”. Many clients got over their suicidal feelings in a few session. But it took longer to get over their feeling of depression. He claims that a number of clients discontinue therapy because of warm approach. In Ellis way of doing therapy is to find out what the client thinks is the problem and start from there. Then check how client is feeling and using RET and how homework , assignments are being carried out. He asked questions what bother you most this week and what do you want to talk about this week etc. He is dissmaid by therapeutic consumerism. He feels that therapeutic time should not be wasted and the therapist should a the client’s problem. Instead of adopting a collaborative stance with the client. Such therapist are afraid of being directive. Ellis complains that the therapist tried to fit the client into RET system. These include behavior therapist, Rogerian therapist and Gestalt therapist. However multimodel therapist have an overlap with RET therapist. The client must be persuaded to therapist view or referred elsewhere.
RET is an eclectic in its techniques but not in its theory which is that disturb people have basic irrationalities which therapist can identify and help clients identify very quickly. Different clients require different techniques, cognitive emotive or behavioral Ellis says that if a client comes in and want something which is bad for him he would try to talk him out of it. Ellis confines his patients to what is on theoretical and practical grounds and is therapeutic.He takes the risk of losing clients because he does not cater to consumerism oriented therapy.He does not practice techniques which provide temporarily relief but do harm later.
Ellis firmly believes the therapist should not go along the client’s consumerism by agreeing to his or her whims regarding therapeutic treatment. (IRTEZA)
To Share or Not to Share?
An interview with Marcia Davis
This interview was taken from Marcia Davis regarding the confidentiality of the therapists’ notes, to determine if the notes should be shared with the clients and does not hinder the process of the therapy. This issue has got very much to do with trust.
She gives the example of man of thirty one who was a school-refuser at the age of twelve. The man has severe personality disorder and had an issue with his previous social worker on the confidentiality. For him the ability to trust and to form a close relationship with another person was quite an issue. He really wanted to know what the therapists thought of him and wanted to read their notes. Silence would feel very hostile to him. Many of the bad negative feelings he had about himself were the things which he believed the therapists held about him as well. And the therapist feels that it is only natural for any human being to know what people write about him/her.
Since the issue of the man was related to trust, the therapist thinks how he was ever really going to learn about trust while she could not trust him in the first place. While, helping him to feel that there were boundaries seemed an important issue on the other side of the fence. The therapist labels this situation as entangling as some of the notes contained very personal reflections of the therapist herself. The therapist even feared that he might in some sense use it against her with her employers. Also, there is always a concern about revealing sexual areas,.
After a lot of thinking, the therapist finally decided to share her notes with the client after considering all the ethical issues related to it despite the opposition of some of her colleagues. She states that there are some patients from whom you learn a great deal, although painfully. Although she was tempted to edit or censor some parts of them but decided not to in the end. She also mentions she felt irritated by the whole issue and it might have been better if she had directly expressed her feelings of irritation towards him.
After having read those notes, the man was depressed at first as it was kind of a mirror to him and he did not like what he saw about himself. However, reading them did help to move him on to face the next issues in the psychotherapy and strengthening of the trust. The therapist also agreed that he could see any further notes she made. She says that it should not alter the way therapists take notes in such cases. The man also came to realise that the therapist was a human and was not perfect and that one could not expect that of a professional. It is important for many patients to know exactly where they stand and where the boundaries lie.
The therapist thinks situations and issues like these are helpful in the growth of the perspective of the therapists. They continually make us think about the values, the contradictions, the behaviour, the views, and the messages we give to others. One session with this kind of patient is worth thirty for the rest of the week. The therapist states in the end that she experienced both a tremendous relief and also a sense of emptiness because though it was so draining, a challenge had disappeared from her life. (saad)