“It’s easy to conceptualize the therapist’s role as being nothing but facilitating—psychotherapy as being primarily an empathic relating. But I think that that misses what the therapeutic task actually is. Therapists, in my view, have to be very clearly themselves, to be able to come from an authentically individualized place so that they are not just emoting or communing or sympathizing, not just providing a field. They have to be really there, and at the same time have to be able to not be so present that they are filling a space too much or intruding. Winnicott is excellent about talking about the middle ground or balance between impinging or intruding and abandoning. It’s easy to misinterpret the kind of presence that Winnicott encourages as being more selfless than a good therapist has to be. Therapists have to be very clear about who they are, and be able to use their own responses and opinions, their own techniques and methods.
At the same time, a therapist has to primarily be able to wait, and wait, and wait, and wait, and not be so anxious to display his or her intelligence or understanding or insights into what they think is going on, and to trust that there will be a time when it is obvious that what needs to be said can be said.” Mark Epstein, MD
I fell in love with Mark Epstein during my Postdoctoral Residency. More than any of my formalized training, his writings shaped me into the clinician I am today. His books taught me that my first task was to learn how to be myself. Next, I had to learn how to “be really there” without taking up the space that my patient needed to inhabit. Mindfulness helped me greatly with these two.
I struggled with learning the waiting part, especially while I was in grad school doing internships and residencies. I had been in grad school for 7 years, and I knew too much for my own good. I was anxious and excited to show my patients all the knowledge I had accumulated. It was very difficult to not throw my insights up onto my patients. In my early years, I had the tendency to want to employ every technique I learned. I later realized that this was due to my inability to truly believe that there was something about my presence that was good enough. It couldn’t be me that they needed. They needed everything I knew…I thought I had to do something amazing, provide great insight, be crafty with my methods.
In grad school, and in training, I loved cognitive behavioral therapy. It made sense to me, but more than anything, it kept me where I felt safe-in my head and dealing with behavioral change. Entering my heart was a bit too daunting. Mark Epstein, Tara Brach, Pema Chodron, and a special postdoc. supervisor, taught me how to trust meeting the life within. Over the years my patients have taught me, time and time again, that it is my heart, not my head, that helps them heal.
Carl Jung was asked how one learns to become a great psychotherapist. His response “Go and read everything written about the art and science of psychotherapy, but then forget it all before you first peer into the human soul.”
We can’t help someone peer into their soul if we haven’t done the work to know our own.