Psychotherapy: Empathic Failures, Great & Small

There is no fun in psychiatry. If you try to get fun out of it, you pay a considerable price for your unjustifiable optimism. ~ Harry Stack Sullivan

            Despite the quote above, Harry Stack Sullivan seems to have a great deal of optimism about the human condition.  He does not believe that our emotional lives are fixed in the first few years of our lives, but created in every moment of our lives.  That is hopeful.  As a therapist, my goal is to enter into relationship with people, join them in that journey of their life, and hopefully help co-create a new reality.  There is nothing more meaningful and humbling than when this occurs.   Sullivan is also the person that points out that as therapists, part of the therapeutic process is recovering from a series of empathic failures on our part as we attempt to connect with our clients. 

            From the moment when the client enters our office for the first time, we attempt to get to know them and their situation.    We try to not overwhelm them by spending too much time on the intake paperwork.  We try to communicate our best understanding of what the client is dealing with and what he or she may be feeling.  In subsequent sessions, we sometimes forget small details of the client’s story and that may feel like a failure to the client who wants to be understood and remembered.  At times, we may presuppose a client is feeling one thing and not be attuned enough to them to realize that they feel something else.  These little failures on the part of the therapist can create small set-backs in the therapeutic process, but Sullivan suggests that the process of therapy is the recovery of the therapeutic relationship from such failures.  I am not an expert in Sullivan’s theory of Interpersonal Psychiatry, but I would imagine that when we begin to recover from such empathic failures in therapy, it helps us to be better equipped to deal with them outside of therapy and even be more tolerant when they occur.  Life is full of little disappointments and the ability to not define any relationship by those moments seems critical to the survival of relationships and authentic happiness.

            Then there are those OTHER moments.  From time to time, our emotional reactions or our misjudgments as therapists result in us having a huge lapse in empathy and completely missing our clients.  In 15 years of doing therapy, my experience has been that after my early years of training, these larger lapses in empathy were fairly rare.  When they occur, however, they often result in clients leaving therapy altogether.  This is one of the most difficult things to deal with as a therapist.  There are some therapists who tend to blame their clients for “lack of readiness to enter therapy” and there may be times when that is true, but as therapists we have to admit that sometimes we mess up.  I am not talking about the gross misuse of a client or horrible bending of the therapeutic boundaries, but the failure to connect with our clients in way that is meaningful. (The client may be fully justified in leaving, especially if the miss is egregious or happens a number of times.)  Many times these types of failures occur when we, as therapists, fail to keep our own emotions and relational “baggage” out of the therapy with another person.  Therapy is about the person in front of us and not about us.  A good therapist must have gone through some process (like their own therapy or another self-reflective experience) to maximize his or her ability to avoid these big empathic misses. 

            Each empathic miss, large or small, becomes an opportunity to learn.  It is a chance to learn more about our clients and more about ourselves.  The therapeutic process at its best is an interaction of two people for the benefit of one of them.  The therapeutic process is co-created by therapist and client and it is the therapist who needs to always be mindful of the process and tending to the client.  We are obviously not perfect at this.  Some are obviously better than others (and some are really bad), but the good therapist recognizes these failures, seeks supervision, does the hard work of introspection, and continues to seek to be better.  Our clients help us and help themselves when they realize that there is a process and that the process is co-created.  Conversation and connection create the holy space for both of us.

Tennessee Has Professional Standards for Pastoral Counselors

I have watched with sadness as the accusations have emerged against Bishop Joseph Walker at the Mt. Zion Baptist Church.  The veracity of these allegations will hopefully be proven in time, but Bishop Walker is not the first to be accused of such abuse of their position.  What makes this sad to me is that the majority of congregational leaders who seek to offer guidance and comfort to their parishioners do so with honor and integrity.  The religious leaders of all faiths seek to meet those in their care at a point of need with the resources of their experience, education, and faith training.  In many cases, these faith resources and the care of the Pastor, Priest, or Rabbi are sufficient to help the care recipient resolve their issues.  However, most religious leaders who have professional training have received only one or two classes in pastoral care and/or counseling.  When the problems that are presented to the congregational leader exceed his or her training, there are many mental health resources to which they may refer, however, Tennessee is one of five states that has a specific license for Pastoral Counselors.  In Tennessee, these professionals are called Clinical Pastoral Therapists and like the majority of clergy in the congregation, these licensed men and women are trained in theology, church history, and biblical studies.  However, unlike many in the local congregation, these Pastoral Therapists have additional education, experience, and supervision that prepare them to deal with more advanced issues of mental illness, mood disorders, partner relationship problems, and other struggles.

 

Clinical Pastoral Therapists must have graduate level training in Theology, usually a Master of Divinity, and graduate level training in counseling or psychology. In addition to these degrees, Pastoral counselors licensed by the state or who have achieved Fellow level membership in the American Association of Pastoral Counselors (AAPC) have additional training in personal formation and clinical work as well as supervision of their clinical work equal to or greater than other mental health providers in Tennessee.  Many Pastoral Therapists in Tennessee are also ordained in their faith tradition.  These theologically trained mental health providers must abide by the ethical standards of their professional organization and must answer to the state of Tennessee for violations of their code of conduct.  Pastoral Therapists are also required to have annual continuing education and most operate with consultation available from peers or other mental health disciplines.  Those who practice in this way are not perfect and some have been accused of abusing their power, however, there are layers of legal and professional accountability that help prevent such abuses; accountability and guidelines that are sometimes absent for those providing counseling in local congregations.

Again, I would say that the majority of spiritual leaders offering care and counseling as part of their ministry in local congregations do so with honor and integrity.  Most people who need assistance would prefer to seek that assistance from someone who understands and respects their faith tradition, but those who are seeking help should also know the education and experience of the person that they approach for help.  They should not be afraid to ask about training, credentials, and license.  In Tennessee it is perfectly legal and acceptable for a member of the clergy to offer care and counseling as part of his or her role in the local congregation, but in those times when someone might desire a religious professional who has more training in counseling and relationships, I would recommend the services of Licensed Clinical Pastoral Therapist. 

Grief is a Common Human Experience, Not a Mental Disorder

Plain Views, the online newsletter for Chaplains and other Pastoral Care Givers recently posted an article that was taken from a Blog by Dr. Joanne Cacciatore on the proposed changes to the Diagnostic and Statistical Manual (DSM) of the American Psychological Association that would remove the exclusion of bereavement for a diagnosis of depression.  In the previous edition, a person could not be diagnosed with depression if the "symptoms" were the result of grieving.  There are a number of reasons that this is problematic and I don't think that I could enumerate them any better than Dr. Cacciatore has.  I would recommend that you read her reflections in her blog by clicking the title above or clicking HERE.  I am grateful that I work for an organization that understands the mental health diagnoses, but is not bound by them.  I am grateful that when the staff of the Pastoral Counseling Centers of Tennessee gathers to reflect on our work with our clients, we are more interested in their story and the circumstances of their lives than making them fit into a diagnostic box or assigning them a label.  The DSM helps provide a common language for professionals, insurance companies and others to talk about mental and emotional difficulties, but there is great power in words and labels.  It seems that the editors of the DSM go a bit too far when they begin to pathologize existential human experiences.  The business of being able to precisely define mental illness is difficult task and one that cannot be taken lightly.  As Pastoral Counselors, we seek to understand each individual and his or her situation.  We use diagnoses sparingly and seek to understand the issues that are common to humanity - community, alienation, hope, despair, sense of the holy, meaning, and purpose - in each client.  As I read the stories of Jesus, I see that he sought to break down the barriers of labels and judgements that people use to marginalize one another.  Compassion, understanding, unconditional love are much more useful tools than a good 5 Axis Diagnosis  on almost any day.  The DSM has it's place and a good clinician should know how to use it, but a good clinician should also know when not to use it also. 

Come With Me, I Want You To See Something (Sermon)

(Click the link above to hear audio of this sermon)

Come With Me, I Want You To See Something

Mark 2:2-9

Chris O’Rear, M.Div., M.M.F.T.

St. Paul’s Episcopal Church

Franklin, Tennessee

February 19, 2012

The story of Jesus’ transfiguration is one of the more debated stories in the Gospels.  Many have questioned whether these events occurred as they were described or if there are embellishments that were added later.  Some have questioned the timeline of the events and when they might have actually occurred.  Others have questioned whether these events occurred at all.  Though I am not a biblical academic, I will observe that the Gospels of Matthew, Mark, and Luke each contain a version of this story and, while there are subtle differences in the re-telling in each Gospel, the content seems consistent.  We take as a matter of faith the events of the Gospel, but the Gospel writers have included this story for a purpose and I want us to understand what that purpose might be.

As I imagined this story this week, I kept thinking of how the events of this day might have begun:  One day, Jesus got up from sleep and as he ate breakfast with his disciples, he said to Peter, James, and John, “I want you all to come with me today.  I have something I think you gonna want to see.”  We know that there were 12 disciples, so I am wondering…how did the other 9 feel about not being asked to go.  Why did the other 9 disciples not get asked to go?  I wonder how they might have felt as Jesus only took the 3 chosen disciples and left them wherever they were doing whatever they were doing.  Did they feel left out?

  At one point in my training, I was working 3 different jobs and was struggling to make ends meet and barely providing for my family. I had a conversation with a woman at her elegant house… as I was delivering a pizza to her door.  Her husband had just purchased a brand new Harley-Davidson motorcycle and was driving the bike around the neighborhood.  With envy, I commented that the bike was beautiful and the woman said, “Well, God has really blessed us this year.”  I have heard others, like you may have, describe how while Christmas shopping, they were so busy shopping and so in need of good parking space and they prayed that God would provide them a space and sure enough, one opened up just as they arrived.  Are these people really chosen and blessed by God while others of us are left to struggle?  Does God really care about parking spaces, motorcycles…or touchdowns for that matter?  For those that have struggled in their life, we sometimes wonder if we are forgotten or if God cares for us at all.

We are confronted with the question about why Jesus chose only Peter, James, and John.  Was it because Peter, James, and John had more spiritual maturity?  Were they Jesus’ favorites?  Did Jesus even have favorites?  If we look further at the Gospel, it certainly might look this way.  In Mark 5, Jesus heals the daughter of a man named Jairus.  As he goes into see the sick girl, the Bible says that he allowed no one to follow him except…guess who…Yep, Peter, James, and John.  It might seem that these three were the chosen ones, but we also see that these three seem to struggle more with the idea that Jesus was not going to be an earthly king with a kingdom and power, but a servant king whose power was in serving others.  At one point, as Jesus described the suffering he would go though, Peter pulled him aside and began to correct him and criticize him for saying such things.  James and John were brothers and they went to Jesus asking if when he came into his kingdom, the two of them could sit one on his right side and one on his left.  Jesus only commented that they did not know what they were asking for.  The Gospel says that the other 10 apostles were indignant that they would ask Jesus for such a favor.  While the other disciples may not have understood it at the time, Jesus seems to have selected these three because they were having the most difficulty grasping the reality of who Jesus was and why he had come.

It seems that again and again in the Gospels that Jesus seems to know what people need when he encounters them.  So many times in the stories of the Gospels, Jesus seems to give each person he encounters just what they need to experience.  When Jesus met the woman at the well, he knew just what to say to her to make a connection with her.   When Jesus was confronted by the group of men who had taken the woman caught in adultery, he knew just what to say to them.   Last week’s Gospel reading included the story of Jesus healing the leper with a touch.  The leper who had lived outside of the community and away from others for so long, Jesus seemed to know that the physical touch would bring healing not just to his body, but to his soul.  In the same way, perhaps Jesus selected these 3 disciples because they most needed to see and hear what was going to happen that day.

What exactly did happen that day?  Whatever it was, it seems to have been for the benefit of the 3 disciples.  They are the focus of the story.  They observe what happens.  They attempt to understand it.  And God speaks directly to them.  It is hard for us to comprehend exactly what happened that day.  We are told that Jesus was “transfigured” in front of them – his face was changed and his clothes became whiter than any TV. spokesperson in a commercial for bleach could even imagine.  For some reason, as I read this passage this week, I kept thinking of Charlton Heston as Moses in “The Ten Commandments” when he came down from the mountain after his meeting with God and his beard was different, his hair was different and he seemed to have an aura that surrounded him.  I guess that is the closest I could come to imagining what happened to Jesus in this story. 

Jesus was joined in the story by Moses and Elijah.  In Luke we are told a bit about what they talked about, but Mark seems satisfied just to note their presence.  If for no other reason, there is significance in Elijah and Moses meeting with Jesus because of who they are.  Moses represented God’s revelation through the Law (the commandments) and Elijah represented God’s revelation through the Prophets.  In this meeting, it is implied that Jesus is the revelation of God in a new way to a new generation.  Peter, James, and John are overwhelmed by what they see and we are told they were afraid.  Peter, who is notoriously impulsive, immediately says that they should build a tent for Jesus,  a tent for Elijah, and a tent for Moses and it is implied in this that they should all just stay there.  Mark is forgiving of Peter’s impulsivity by saying, “Peter just said that because they were so afraid and nobody knew what to say.”  However, Peter’s response seems pretty normal to me for the experience.

Have you ever had an experience of the holiness of God and just wanted to stay there.  Some of you may remember the experiences on the mission trip or at a summer camp.  Some of you  have had  those moments in your life when you feel particularly close to God – at the birth of a child, in a special time of worship, while hiking in the mountains or visiting at the beach.  In those moments, you don’t want to leave.  You may think, as Peter does, let’s just build a house  here and stay.  Those experiences of spiritual highs can be powerful, but if we are not careful, they can be fleeting.  In those moments, we feel so close to God and so connected with those around us, but then we return to the “real world” with school, work, traffic, and all the terrible things in the news and those feelings can begin to fade.  We lose the focus until the next event that makes us feel close to God.  Peter was so excited to be where he was that he just wanted to stay…but they could not stay.  They heard the voice of God say of Jesus, “This is my son.  Listen to him.”  To listen in this context is not just to hear the words, but let them seep into the fabric of our being and affect our life and our actions.  To listen, in this context, is about taking the teachings of Jesus to heart and letting them transform us.  I found an interesting fact this week in my studies.

In the book of Romans (12:2), Paul writes the following: 

And do not be conformed to this world, but be transformed by the renewing of your mind, so that you may prove what the will of God is, that which is good and acceptable and perfect.

The word “Transformed” in this passage is used two other times in the New Testament.  In 2Corinthians, it is also translated as “transformed”, but in the Gospel of Mark, it is translated as “Transfigured”.  The word for Jesus being transfigured is the same word that is used to talk about the transformation that should occur in the believer’s life.

And do not be conformed to this world, but be transformed by the renewing of your mind, so that you may prove what the will of God is, that which is good and acceptable and perfect.

“That which is good and acceptable and perfect” comes from the teachings of Jesus, the life of Jesus, and the example of Jesus.  We are to “Listen” to this, to emulate this, to be transformed into this.  Sometimes we are frightened when we grasp the magnitude of what we are asked to do.  Sometimes we are at a loss of what to do or how to live this out.  I don’t know, God may really care about parking spaces and touchdowns, but the life and words of Jesus would indicate he loves those that are hurting and those in need.  The life of Jesus would indicate that we should seek to meet people where they are and seek to provide them with what they need.  The teachings of Jesus tell us that those who seek to save their life, will lose it and those that try to be first will be last.  Jesus’ teaching turns the world as we know it upside down.  Power is not in ruling like a king, but serving like a servant.  Jesus has invited you to see his life and his place in history.  The voice of God beckons us to listen.  Can you hear?  What will you do?

The Sky is Falling and It's All Your Fault

I have two primary theories that inform my therapy with my clients; object relations theory and family systems theory.  I am acquainted with a number of other theories.  What I have learned through the years is that what theory you use with a client is not as important as establishing a good relationship with the client.  There are several qualities that make for good rapport, but none more important than being a “non-anxious presence”.  The term “non-anxious presence” comes from the family systems theory, but has such a broad potential for application.  Being the non-anxious presences means that as the person in front of you is getting more and more anxious that you resist the urge to join them in that intensity.  Being a non-anxious presence means that when the person with you discloses something that is shocking to you on the inside, that you don’t show it on the outside.  Being a non-anxious presence means that you do not jump to conclusions, you don’t overreact, you don’t judge and you don’t get lost in your own emotions.    

To be really good at doing this, a person must have done sufficient work on their own internal world; tending to their own hurts, their own biases, their own beliefs, and their own arrogance.  To be good at  being a non-anxious presence requires a degree of humility.  It means entering into the other person’s world so that you can understand things from their perspective without losing yourself.  To do this, you really have to know yourself, but not be hung up on yourself.  Being open to the other requires allowing others to explore their own thoughts and make their own choices (and live with their own consequences).  It does not mean that we don’t express our thoughts or concerns, but it does mean that we don’t try to control the outcome for the other person.  To be a non-anxious presence, we have to tend to our own fears, manage our own emotions, think through our own actions before we become “reactive”.  Being present with another person in this way, demonstrates our inherent trust in the other person and God to ultimately figure things out.  Being present in this way means not trying to control another person’s life and dictate the outcome of their story; it is seeking to be loving.  For me, it is the way that God demonstrates love to us.  Allowing us to figure things out and learn from our choices, but supporting and loving us on our journey.

The opposite of this can be seen in so many places, but it is particularly disturbing to me to see it in families, churches, and politics.   It seems that social media like Twitter and Facebook and 24/7 news coverage provide people the opportunity to comment on events and people without careful reflection and complete understanding.  When we reduce people to sound bites, exaggerate their views (or flat out lie about them) to create fear we are being emotionally reactive and manipulative.  When we reduce people to labels and belittle them for their thoughts we are separating ourselves from the image of God in another human being.  When we ostracize others because they are different than us we are denying the freedom of each person and the interdependence of our lives.  I am continually saddened to see religious leaders – conservative, moderate, and liberals – who demonize those who are different from themselves and respond with knee-jerk reactive comments.  I am disgusted by politicians that create unrealistic fears to emotionally manipulate the public.  In our families, in our churches, in our society, we need more people who are willing to do the difficult work of introspection in order to offer the world a more non-anxious presence.  I know it brings healing in a therapy relationship.  I know it breeds healing in personal relationships.  I don’t know why it would not benefit society as a whole.

Reflections on Matthew 14:23 - 33

 

As I step out of the boat onto the sea that should not hold me
I am amazed that I am doing what I thought impossible.
I am trying to stay focused on the one that makes all things possible
And trust that I will not sink, but should I sink, I will not drown.
If I focus on what I am doing and all I could lose and not on the one that makes it possible,
I will grow anxious and sink.
Trusting that whether I walk or sink, I am in the care of the one who calls me –
That is my peace. That is where I want to be.
Lord, calm the wind of fear. Lord, support me in my doubt.

Me and Mrs. Jones

     “Me and Mrs. Jones” was a number one hit for soul singer Billy Paul in 1972.  I have always loved the song and not because of its questionable themes (at the time this song’s release, those themes were lost on my naïve 8 year-old self).  I always liked the song because it made me think of my second grade teacher, Mrs. Jones.  While I don’t remember a whole lot about what we learned in the second grade, I remember Mrs. Jones.  Mrs. Jones was a kind and wonderful woman who made each day at school a joy.  She had way of making me feel welcomed and important each day.   When Mrs. Jones spoke to me, I felt cared for.  There were other teachers that I had through the years that stand out to me for many reasons – some rich and wonderful and some not so much.  However, what makes Mrs. Jones unique was that she was African-American. 

                I grew up in Alabama (Birmingham and Tuscaloosa).  As I have learned my history, I realize that it was no small thing for me to have black students in my class and black teachers in my school.  What is so wonderful to me now is to realize that, for me, it was no big deal.  Because of the sacrifice of others who fought for equality and a higher calling, I grew up without knowing a world of segregation and separation.  Because of the openness of my parents to have high school and college students in our home of every color and nationality, I learned of our common humanity and not a separation of color.  I did grow up in a culture where there were vestiges of the old ways in the form of blatant and many more subtle forms of prejudice.  Over time I began to try to rid my life –as best I could – of those things that were still a part of my life.  I did this because of people like Mrs. Jones and many others.  How could I tell certain jokes or say certain things I had learned through the years about the kind and wonderful people who had such an impact on my life.

                On this Martin Luther King, Jr. day, I am saddened by the heritage of division and hatred that has existed in this country and around the world.  It is even more disheartening to see that these things still go on in various forms.  For me, Mrs. Jones was not my “black teacher”; she was a kind and wonderful woman.  I pray that one day our children will live in a nation where people will not be judged by thecolor of their skin (whatever color it is), but by the content of theircharacter.