HIE THEE HOMEWARD

Walking home just now, I overheard two couples talking. I’m a brisk walker and was overtaking them. One was saying to the others, “They were very tender tonight.” Par for the course with me, I assumed they were talking about people. Tender people–it was such a warming thought. It turns out they were talking about scallops.

The environmentalist in me would like to send you directly to The New Yorker, the March 8 issue, to read about the disaster that is the worldwide fishing industry, devastating ecosystems and traditional fishing communities both. That’s not to mention the state of the waters themselves, the plastic, the chemicals. However, this bit of writing is about therapy.

A client’s boyfriend was depressed and using substances. She was afraid he might be suicidal, and his reassurance wasn’t much comfort–only because of her, he wouldn’t hurt himself. She asked him to see a therapist, and his response was that he didn’t want to pay someone to listen to him.

I feel sympathy for that sentiment. To me it says less about my profession than it does about the widespread and entirely comprehensible hunger people have for real intimacy and support. I do think there are some misconceptions in that statement, though, as well. Good therapy is about much more than just being “listened to” in some timed and compensated way. Among other things, it’s an opportunity to know and speak our truths more clearly, to shape our preferred narratives.

Many people in our lives–good, bad, or indifferent–lack the skills or insight to meet our needs, or their own needs conflict with ours in ways that don’t result in satisfactory compromise. We can walk through the world in a state of confusion, our powers of reason working overtime to sort through the cognitive dissonance: If we really deserved consideration, we would get it, so working backwards, the fact that we don’t get it must mean we don’t deserve it.

Good therapy holds open a sacred space, yes, but the goal is for clients ultimately not to need it because they’ve reached a point of getting what they need within their personal spheres–with family, with partners, at work, among friends. It’s a transformation I’ve been privileged to witness many times. I don’t mean that last statement to ring of false humility or passive enabling of change; I take an active role in my work. But transformation is something greater, irreducible to input and output, “evidence-based practices” notwithstanding.

I’m not talking about “evidence-based practices,” however well-studied they may be, however nicely their results can be graphed. I’m talking about corrective experiences, the back-filling of holes, the healing of wounds. I’m talking about tenderness, joy, logic, laughter. Present-moment learning. To quote Ted Lasso–any excuse!–“I’m talking about practice.”

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MANUALIZED LABOR

 

When I contemplated a career in therapy, one of the elements that made my eyes light up was the prospect of continuing education. I looked forward to formal learning that never stopped, imagining something akin to master classes by the greats of the field. I didn’t imagine hauling ass through rush hour traffic to watch PowerPoint presentations illustrated with memes.

So far only about twenty percent of trainings have inspired me in my work—a pretty shabby average. The rest have just cost time and money when I can’t spare either for things that don’t feel essential. Like most licensed professionals, though, I’m required to meet a quota of CEUs.

Still evolving within the work, I nonetheless developed the core of my professional identity and preferences relatively early, with the support of an exceptional first-year internship supervisor, who emphasized the primacy of the therapeutic relationship and the value of simply, truly meeting clients where they’re at.

That’s not to say that my supervisor, a school social worker with an agency background, didn’t utilize specific strategies, tools, and techniques—in her case, an adventure-based approach along with play therapy. Rather, those things became a seamless part of her work and never took precedence over the present-moment needs of the kids she saw.

The therapeutic modalities that so often comprise the training opportunities available, by comparison, tend to seem rote and too directive in their approach. Or they feel so to me. “Visit one is for general assessment using the XYZ Mental Health Inventory; visit two is for problem-identification with cognitive mapping; visit three…” Etc.

There are many reasons for the manualization of therapeutic processes, including the mandate for brief therapy imposed by insurance companies, and the “soft science” complex that haunts a profession seeking status in a mechanistic, data-driven world.

People who know me would probably agree that I’m a stickler about many things, from the quality of the food I buy down to the commas in a piece of writing. But holding clients to a rigid framework ain’t my scene.

You could say I care more about “practice-based evidence” than I do about “evidence-based practice.” EBPs can certainly boast success stories, and I’m sure they work best when employed by their strongest adherents. Yet I know many clients who’ve “graduated” from CBT, DBT, and other acronymnal programs and express that they consider themselves none the better.

Then there are the trainings that feel like mere repackaging of modalities that have come before, the therapeutic equivalent of the “seven basic plots” in literature. In cynical moments, you might catch me saying, Maybe if I took mindfulness, broke it into ten components, and called it “Experiential Sensory Integrity Development (ESID),” I could start a 401K on the proceeds?

Many trainings seem to involve no actual “training” whatsoever, merely glossing their subject matter within advertisements for certification processes that cost upwards of ten times as much as the cost of admission for the 6 out of 40 CEUs you’re sitting there to earn, before your two licensed years are up and you (pay an additional fee to) start again.

To put it metaphorically, the latter type of training consists of allusions to a destination that lies perpetually just around the bend. The scenery feels so unchanging, in the classroom or conference room or partitioned hotel space—Warning: complimentary peppermints contain red dye and GMO corn syrup—it’s as though the vehicle is immobile. In those cases, the answer to “Are we there yet?” is, There is no “there” there.

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If only I could write book reports to earn my CEUs… I’m deeply grateful for my readers, and as always, I’d love to reach more. If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage.

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